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
From United States, Charlotte
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
From United States, Charlotte
HEALTH CARE/MEDICARE/WELFARE VS. WELLNESS
Health care/Medicare/welfare measures by an employer for his employees is conventional and known in general. The cost is either adjustable with the remuneration of the employees or contributory or forms part of the terms and conditions of employment. The employee in such conventional arrangement is only beneficiary and not expected to do any thing.
Whereas wellness is a new concept and the employee will have to take part all along. Wellness refers to soundness in mind, body and spirit resulting in increased comfort and competency. So by definition it appears attractive but going about it is not that easy. It requires knowledge, initiation and practice. In the first two levels involvement of both employer and employee is necessary but in the last level the employee will have to go by himself/herself.
Wellness has three components. Appropriate cognition, physical exercises and nutrition. Appropriate cognition refers to right attitudes, healthy thoughts and inclination for healthy lifestyles. The major techniques are guided imagery, affirmations, right meditations, biofeedback and hypnosis. All these techniques are curative, preventive and enhancer of sound mind, body and spirit.
Physical exercises of one or other kind are known to all but unless one acquires proper mental predisposition he/she will not do any physical exercises. The most common physical exercises are yogasanas, pranayama, aerobics and neurobics.
Body requires proper nutrition to be fit. To prevent unhealthy and unhygienic food intake by their employees, I think, certain companies provide cooked food to them. Of course, may be that food is prepared with the advice of nutritionists.
So I think wellness discussion be differentiated from conventional health care/Medicare/welfare measures.
Regards,
jogeshwar
From India, Delhi
174Health care/Medicare/welfare measures by an employer for his employees is conventional and known in general. The cost is either adjustable with the remuneration of the employees or contributory or forms part of the terms and conditions of employment. The employee in such conventional arrangement is only beneficiary and not expected to do any thing.
Whereas wellness is a new concept and the employee will have to take part all along. Wellness refers to soundness in mind, body and spirit resulting in increased comfort and competency. So by definition it appears attractive but going about it is not that easy. It requires knowledge, initiation and practice. In the first two levels involvement of both employer and employee is necessary but in the last level the employee will have to go by himself/herself.
Wellness has three components. Appropriate cognition, physical exercises and nutrition. Appropriate cognition refers to right attitudes, healthy thoughts and inclination for healthy lifestyles. The major techniques are guided imagery, affirmations, right meditations, biofeedback and hypnosis. All these techniques are curative, preventive and enhancer of sound mind, body and spirit.
Physical exercises of one or other kind are known to all but unless one acquires proper mental predisposition he/she will not do any physical exercises. The most common physical exercises are yogasanas, pranayama, aerobics and neurobics.
Body requires proper nutrition to be fit. To prevent unhealthy and unhygienic food intake by their employees, I think, certain companies provide cooked food to them. Of course, may be that food is prepared with the advice of nutritionists.
So I think wellness discussion be differentiated from conventional health care/Medicare/welfare measures.
Regards,
jogeshwar
From India, Delhi
Dr. Jogeshwar,
You make a very interesting point. After reading your thoughts, I realized that people from all over the world are participating in this discussion. When first initiated, this topic was directed to a North American audience. Let me explain: The US government only pays for healthcare costs associated with people that are over 65 and have contributed for a certain number of years into a fund (social security). Anyone NOT yet 65 is on their own. Therefore, business has been primarily responsible for paying the medical costs (ie: insurance) for their workers. (In most other countries, healthcare is handled by the government.) Healthcare costs have been steadily rising here - due to several factors - and will soon represent 50% of the total cost of a worker. In other words: healthcare will quickly become a more important cost than salary. The "wellness" I have been referring to relates to practical, onsite solutions for American businesses looking to stave off the increasing burden of healthcare - not the spiritual one you refer to. YES, you are correct in what you say, but that will not resolve the urgent need American companies have today.
From United States, Charlotte
You make a very interesting point. After reading your thoughts, I realized that people from all over the world are participating in this discussion. When first initiated, this topic was directed to a North American audience. Let me explain: The US government only pays for healthcare costs associated with people that are over 65 and have contributed for a certain number of years into a fund (social security). Anyone NOT yet 65 is on their own. Therefore, business has been primarily responsible for paying the medical costs (ie: insurance) for their workers. (In most other countries, healthcare is handled by the government.) Healthcare costs have been steadily rising here - due to several factors - and will soon represent 50% of the total cost of a worker. In other words: healthcare will quickly become a more important cost than salary. The "wellness" I have been referring to relates to practical, onsite solutions for American businesses looking to stave off the increasing burden of healthcare - not the spiritual one you refer to. YES, you are correct in what you say, but that will not resolve the urgent need American companies have today.
From United States, Charlotte
Dear Raul, and exactly for the same reasons mentioned by you HEAL THYSELF is the motto in mind, body medicine. Regards, Jogeshwar
From India, Delhi
From India, Delhi
Dr.,
I don't disagree - you are correct. The problem is that if people had the fortitude of "healing thyself" in the first place, 50% of the problem would go away! Example: in the USA, obesity happens to be an epidemic. It causes diabetes type 2 in over 18 million people. The expenses associated with this (preventable) issue are huge (billions) and is just one example of what I'm referrig to. My point: American companies need to have a program with clear INCENTIVE and DISINCENTIVES for participation and compliance. If left voluntary, people will continue down the same path.
RR
From United States, Charlotte
I don't disagree - you are correct. The problem is that if people had the fortitude of "healing thyself" in the first place, 50% of the problem would go away! Example: in the USA, obesity happens to be an epidemic. It causes diabetes type 2 in over 18 million people. The expenses associated with this (preventable) issue are huge (billions) and is just one example of what I'm referrig to. My point: American companies need to have a program with clear INCENTIVE and DISINCENTIVES for participation and compliance. If left voluntary, people will continue down the same path.
RR
From United States, Charlotte
Dear Raul,
Namaskar. Be sure, I am talking science and not fiction. Now there are scores of alternative/complementary medicines under experience all over the world. National Institute of Health has a well infrastructured center for alternative/complementary medicines. This is for the sole purpose of reducing treatment cost. Of course, with the passage of time some of the alternative/complementary medicine techniques will disappear but many of them will become sharper.
My emphasis is on mind body medicine. The basic propositions of mind, body medicine are:
1. Body has and can generate much more chemicals than science has discovered so far.
2. Health requires optimum levels of necessary chemicals.
3. Body not only degenerates but also regenerates.
My target is not less than any 100%. So I have already mentioned in my first response above that for at least last 5 years I have nil medical bill. For that, one requires knowledge, initiation and practice.
Regards,
jogeshwar
From India, Delhi
Namaskar. Be sure, I am talking science and not fiction. Now there are scores of alternative/complementary medicines under experience all over the world. National Institute of Health has a well infrastructured center for alternative/complementary medicines. This is for the sole purpose of reducing treatment cost. Of course, with the passage of time some of the alternative/complementary medicine techniques will disappear but many of them will become sharper.
My emphasis is on mind body medicine. The basic propositions of mind, body medicine are:
1. Body has and can generate much more chemicals than science has discovered so far.
2. Health requires optimum levels of necessary chemicals.
3. Body not only degenerates but also regenerates.
My target is not less than any 100%. So I have already mentioned in my first response above that for at least last 5 years I have nil medical bill. For that, one requires knowledge, initiation and practice.
Regards,
jogeshwar
From India, Delhi
Dear friends,
Namaskar.
May I conclude it now?
We have two paths to health.
PATH NO.1
Heal thyself.
PATH NO.2
Baidyaraja namastubhyam,
Yamaraja sahodara.
Yama harati pranani,
Baidya harati dhanani, pranani cha.
English Translation.
Oh master of physicians,
The uterine brother of god of death,
I bow down before you.
God of death robs off life,
Physician robs off wealth and life both.
PATH NO.3
Does not exist.
Regards,
jogeshwar.
From India, Delhi
Namaskar.
May I conclude it now?
We have two paths to health.
PATH NO.1
Heal thyself.
PATH NO.2
Baidyaraja namastubhyam,
Yamaraja sahodara.
Yama harati pranani,
Baidya harati dhanani, pranani cha.
English Translation.
Oh master of physicians,
The uterine brother of god of death,
I bow down before you.
God of death robs off life,
Physician robs off wealth and life both.
PATH NO.3
Does not exist.
Regards,
jogeshwar.
From India, Delhi
Raul:
I think we agree in principle that wellness programs are beneficial to the consumer (employee/dependants), and the provider (employer). Where we disagree is in the application of the program.
Some background: Before becoming a consultant, I worked in a "rust belt" industry - Manufacturing plant (metal casting/machine shop environment); 450 hourly employees, 3 shifts, 5-6 days/week.
Full time RN on staff/on site daily, (except Saturday), dispensing minor medication, providing a compassionate ear and responding to accidents as needed.
Part time MD, one day/week. Function: to “clear” employees to return to full time, unrestricted duty; also respond in the event of a serious accident as well as follow-up on Worker Comp cases. In addition, he provided guidance to, and answered any questions the RN had.
RN had contacts with various agencies in the county (Blood Bank, Lung Association, Diabetes Association, and others), and used them to establish a wellness program without a “wellness program headquarters”. As a result of the various agencies’ response (they brought their own vans filled with testing equipment) a significant number of employees found they had chronic conditions - high blood pressure, diabetes, the beginnings of emphysema, etc. Those cases were referred to their personal physician for follow up and treatment as determined by the doctor. The RN, with the employee’s voluntary permission and in compliance with the privacy rules at that time, monitored compliance with face to face consultation/ reinforcement/ tracking on a regular basis.
The program was so well received that the following month, on a Saturday, we did the same thing for dependents.
The system that you pooh- poohed as “few will use them and there is no control over it (standardization)…just helping a few individuals here and there isn’t enough.” WORKED and WORKED WELL. My directive was to get maximum utilization from available resources.
In your reply on 5/13/05, I read an idealistic scenario. Such a plan is impractical, unrealistic and cost-inefficient. Savings realized from wellness are spent on non-productive bureaucratic structures, administrative/professional fees and costs related to furnishing/supplying the clinics. Don’t know what industry you are in but from your view on how a wellness program works (or should work), they must be making money hand over fist.
* What is reasonable hourly rate for NP? For MD?
For Wellness Program Headquarters personnel?
* “hours are pre-set”…”determined by the number of
employees (or …spouses {and dependants}…also utilize the
clinics)”.
Does consumer make appointment?
With whom? The clinic or the Wellness Headquarters?
What happens when consumers (employees/
dependants) overwhelm the clinic and staff?
Assembly line care, half-hearted consultation, hap-
Hazard diagnosis, erroneous conclusions and wrong
meds? OR extraordinary waiting time?
* “wellness program headquarters is responsible for
monitoring that NP's “
Isn’t that the function of the MD?
Who is monitoring NP - Administrative personnel?
Bureaucrat? NP? MD?
* “We have found“…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".
Who is “we”?
How were conclusions “found” ?
In surveys done for the High Deductible Healthcare Plan
(HDHP), statistics show that consumers are more prudent
and selective when spending their own money, then they
are when having the blank check of unlimited medical
coverage. In the past, when “little Johnny, or Jeannie” had
a sore throat, a “home remedy”, or non-prescription over
the counter medication was given. Today, parents are
taking their children to the doctor for "minor problems
that might soon go away".
* “important motivator to program participation is that
employees can access primary health care, get prescriptions
filled, all at zero cost to them.”
I would like to hear more details regarding the “cost
Free” health care and prescription plans.
* “traditional Managed Care organizations have been
preaching LIMITING services as a way of saving money. "
In the past, I have negotiated with Managed Care
Organizations (MCO) and set the terms and conditions
of service. As they solicited our business, I informed
them of the parameters I was seeking - “as needed,
reasonable diagnostic tests, etc.” If they didn’t like it,
they didn‘t arrange for a presentation. You would be
surprised at the number of MCO’s that wanted the
business bad enough to be willing to design a program
that would save us money in the long run. To
paraphrase one of your points -
It’s cheaper to prevent than treat an illness.
Remember, you have the money and they want what you have.
Wellness programs are not about “making quality primary care available to those with chronic conditions”. It is about identifying the problems, counseling and encouraging life style changes - more exercise, quit smoking, eat healthy, etc. It is also incumbent on the consumer to take responsibility for his/her actions and judiciously utilize the health benefits provided by the employer.
We don’t need “…multiple "tricks" to get the whole thing to work“; “tricks” are what got us into this situation. We simply need caring professionals who are willing to help consumers uncover, recognize and treat their chronic conditions while supporting them with personal concern and encouragement. Word of mouth will do the rest.
To Dr. Mahanta:
You make some excellant points regarding spirituality/ faith as it is applied to disease/illness. How many times have we heard physicians and other care givers proclaim "It's a miracle!!!"
From United States,
I think we agree in principle that wellness programs are beneficial to the consumer (employee/dependants), and the provider (employer). Where we disagree is in the application of the program.
Some background: Before becoming a consultant, I worked in a "rust belt" industry - Manufacturing plant (metal casting/machine shop environment); 450 hourly employees, 3 shifts, 5-6 days/week.
Full time RN on staff/on site daily, (except Saturday), dispensing minor medication, providing a compassionate ear and responding to accidents as needed.
Part time MD, one day/week. Function: to “clear” employees to return to full time, unrestricted duty; also respond in the event of a serious accident as well as follow-up on Worker Comp cases. In addition, he provided guidance to, and answered any questions the RN had.
RN had contacts with various agencies in the county (Blood Bank, Lung Association, Diabetes Association, and others), and used them to establish a wellness program without a “wellness program headquarters”. As a result of the various agencies’ response (they brought their own vans filled with testing equipment) a significant number of employees found they had chronic conditions - high blood pressure, diabetes, the beginnings of emphysema, etc. Those cases were referred to their personal physician for follow up and treatment as determined by the doctor. The RN, with the employee’s voluntary permission and in compliance with the privacy rules at that time, monitored compliance with face to face consultation/ reinforcement/ tracking on a regular basis.
The program was so well received that the following month, on a Saturday, we did the same thing for dependents.
The system that you pooh- poohed as “few will use them and there is no control over it (standardization)…just helping a few individuals here and there isn’t enough.” WORKED and WORKED WELL. My directive was to get maximum utilization from available resources.
In your reply on 5/13/05, I read an idealistic scenario. Such a plan is impractical, unrealistic and cost-inefficient. Savings realized from wellness are spent on non-productive bureaucratic structures, administrative/professional fees and costs related to furnishing/supplying the clinics. Don’t know what industry you are in but from your view on how a wellness program works (or should work), they must be making money hand over fist.
* What is reasonable hourly rate for NP? For MD?
For Wellness Program Headquarters personnel?
* “hours are pre-set”…”determined by the number of
employees (or …spouses {and dependants}…also utilize the
clinics)”.
Does consumer make appointment?
With whom? The clinic or the Wellness Headquarters?
What happens when consumers (employees/
dependants) overwhelm the clinic and staff?
Assembly line care, half-hearted consultation, hap-
Hazard diagnosis, erroneous conclusions and wrong
meds? OR extraordinary waiting time?
* “wellness program headquarters is responsible for
monitoring that NP's “
Isn’t that the function of the MD?
Who is monitoring NP - Administrative personnel?
Bureaucrat? NP? MD?
* “We have found“…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".
Who is “we”?
How were conclusions “found” ?
In surveys done for the High Deductible Healthcare Plan
(HDHP), statistics show that consumers are more prudent
and selective when spending their own money, then they
are when having the blank check of unlimited medical
coverage. In the past, when “little Johnny, or Jeannie” had
a sore throat, a “home remedy”, or non-prescription over
the counter medication was given. Today, parents are
taking their children to the doctor for "minor problems
that might soon go away".
* “important motivator to program participation is that
employees can access primary health care, get prescriptions
filled, all at zero cost to them.”
I would like to hear more details regarding the “cost
Free” health care and prescription plans.
* “traditional Managed Care organizations have been
preaching LIMITING services as a way of saving money. "
In the past, I have negotiated with Managed Care
Organizations (MCO) and set the terms and conditions
of service. As they solicited our business, I informed
them of the parameters I was seeking - “as needed,
reasonable diagnostic tests, etc.” If they didn’t like it,
they didn‘t arrange for a presentation. You would be
surprised at the number of MCO’s that wanted the
business bad enough to be willing to design a program
that would save us money in the long run. To
paraphrase one of your points -
It’s cheaper to prevent than treat an illness.
Remember, you have the money and they want what you have.
Wellness programs are not about “making quality primary care available to those with chronic conditions”. It is about identifying the problems, counseling and encouraging life style changes - more exercise, quit smoking, eat healthy, etc. It is also incumbent on the consumer to take responsibility for his/her actions and judiciously utilize the health benefits provided by the employer.
We don’t need “…multiple "tricks" to get the whole thing to work“; “tricks” are what got us into this situation. We simply need caring professionals who are willing to help consumers uncover, recognize and treat their chronic conditions while supporting them with personal concern and encouragement. Word of mouth will do the rest.
To Dr. Mahanta:
You make some excellant points regarding spirituality/ faith as it is applied to disease/illness. How many times have we heard physicians and other care givers proclaim "It's a miracle!!!"
From United States,
Bill,
I has happy to read your response and the intelligent issues you raised – it’s much easier (and more fun) dealing with smart than dumb. I’ll try to respond in kind and address your points. SOMEBODY has to direct the orchestra, but If you can get someone in the organization to take charge and manage any program for FREE, or included in their salary – of course, why compete with that? (hey, maybe this should be a standard addition to HR directors job descriptions?) I think you’ll find existing personnel have their plate fairly full and would rather sub-contract this out.
First: RN’s can’t prescribe anything except over the counter meds. NP’s can and do prescribe anything a Dr can and this is why a supervising Dr+Np set-up is the most efficient combo.
1) Nobody said there was only ONE way to skin a cat. The scenario you described with a caring RN is great and appears to have worked in your example – try to duplicate that across the board elsewhere. What happens with an organization that DOESN’T have mother Theresa RN and wants to implement a program in 4 different plant locations? I’m talking about a “clone-able” system that can be reproduced and implemented where needed.
2) “The program was so well received that the following month, on a Saturday, we did the same thing for dependents” = check your records: dependents are more costly to the plan than the employees themselves! Dependents (not under 14) are encouraged to use the facilities, just as employees.
3) “I read an idealistic scenario. Such a plan is impractical, unrealistic and cost-inefficient. Savings realized from wellness are spent on non-productive bureaucratic structures, administrative/professional fees and costs related to furnishing/supplying the clinics” = WOW, and that was even before I even mentioned how much it cost!!! Sounds like you’re already against it before it starts Bill.
4) What is reasonable hourly rate for NP? For MD? For Wellness Program Headquarters personnel? = Physician supervision PLUS Nurse Practitioner time will vary depending on area in USA, but generally anywhere between $60 and $70 per hour for BOTH. Once the initial visits are out of the way and patients are seen routinely, an average NP will see about 3 patients an hour. Make a quick division and tell me if you think this is inefficient and expensive. “Wellness Headquarters” = This will also vary depending on number of program participants, but roughly $1.25 to $2.00 per program participant per month. (you think that’s an overbloated price and bureaucracy?)
5) Does consumer make appointment? With whom? The clinic or the Wellness Headquarters? = every organization has their own pet way, but the most usual is an open calendar on the clinic door where anyone can walk by and write their name in an (open) appointment.
6) What happens when consumers (employees/ dependants) overwhelm the clinic and staff? = my first question is: what’s the REASON for the overwhelmed appointments? If the visits are episodic and NOT part of a comprehensive chronic risk management program – it’s a waste of time (as happens when you don’t have any control and just leave it as a “free for all”). Every program participant needs to know that the NP is there to manage chronic risk conditions, not runny noses.
7) “Assembly line care, half-hearted consultation” = Wrong. My experience is that NP’s take their job very seriously and like what they do. Because money has been taken out of the equation (they don’t get paid fee for service, remember?) they concentrate on their patient care.
8) “hap- Hazard diagnosis, erroneous conclusions and wrong meds? = Sorry, you can pay as much as you like and STILL run the same risk. This is a hazard when dealing with humans – regardless of the money involved. No guarantees either way. Someone NOT liking the advice can always seek care elsewhere.
9) “OR extraordinary waiting time?” = It’s important to try and estimate the number of hours needed correctly. Wait time? You’re thinking in terms of a doctor’s office! Times are very generously set - more so than in a regular Dr’s office with many rooms and practitioners in a “patient mill”.
10) Who is monitoring NP - Administrative personnel? Bureaucrat? NP? MD? = There are 2 people monitoring the NP. From a CLINICAL perspective, the supervising Dr. The “bureaucrat” makes sure that the NP has all supplies she/he needs and is addressing chronic risk issues at every visit (minimal runny nose cases). It’s important to stay focused and the bureaucrat is there to help keep everything in track from an operational standpoint. You may think management isn’t worth the time of day – if so, I assume you’re not a manager of any kind.
11) Who is “we”? = me, myself and my organization.
12) How were conclusions “found”? = experience in actual settings.
13) In surveys done for the High Deductible Healthcare Plan (HDHP), statistics show that consumers are more prudent
and selective when spending their own money, then they are when having the blank check of unlimited medical coverage. = to me, this is a laughable conclusion – VERY “insurance-like” and EXACTLY how I used to think when I was in the HMO business! At that time, we were convinced that “abusive patients” were breaking the bank and somehow needed to be pushed away from care in order to save money. We feel ENHANCING access to care – not limiting it – is what’s needed to keep chronic conditions in check.
14) In the past, when “little Johnny, or Jeannie” had a sore throat, a “home remedy”, or non-prescription over
the counter medication was given. = Children aren’t even eligible to participate in this program – you’re mixing apples with oranges. Besides, have you ever heard the word “triage”? There are many ways to “filter” the sore throats to a serious condition by trained personnel that are not Dr’s. But in reference to what you’re talking about: there are countless 3rd world countries that have this exact scenario happen daily. If you’re comfortable with the infant mortality rates, so be it. I’m not and consider this an unacceptable level of care.
15) I would like to hear more details regarding the “cost Free” health care and prescription plans. = I meant employees get a PRESCRIPTION for a particular medication for free, not Free medications. Under most plans now, an employee has to visit a Dr, pay the co-payment, take off time from work and THEN pay for the medication.
16) It is also incumbent on the consumer to take responsibility for his/her actions and judiciously utilize the health benefits provided by the employer. = This is so obvious, I didn’t think it had to be mentioned! OF COURSE the employee has to take responsibility! The program allows the company to measure and quantify this. How? By monitoring COMPLIANCE. Without the program, you have no data, no idea what’s going on besides an increase in costs.
17) We don’t need “…multiple "tricks" to get the whole thing to work“ = I have no idea what “tricks” you are referring to. I’m talking about a professional program that contracts with professionals all along the way.
I hope I’ve addressed all your points questions, but if not – please write and I’ll try to address each one.
Raul
From United States, Charlotte
I has happy to read your response and the intelligent issues you raised – it’s much easier (and more fun) dealing with smart than dumb. I’ll try to respond in kind and address your points. SOMEBODY has to direct the orchestra, but If you can get someone in the organization to take charge and manage any program for FREE, or included in their salary – of course, why compete with that? (hey, maybe this should be a standard addition to HR directors job descriptions?) I think you’ll find existing personnel have their plate fairly full and would rather sub-contract this out.
First: RN’s can’t prescribe anything except over the counter meds. NP’s can and do prescribe anything a Dr can and this is why a supervising Dr+Np set-up is the most efficient combo.
1) Nobody said there was only ONE way to skin a cat. The scenario you described with a caring RN is great and appears to have worked in your example – try to duplicate that across the board elsewhere. What happens with an organization that DOESN’T have mother Theresa RN and wants to implement a program in 4 different plant locations? I’m talking about a “clone-able” system that can be reproduced and implemented where needed.
2) “The program was so well received that the following month, on a Saturday, we did the same thing for dependents” = check your records: dependents are more costly to the plan than the employees themselves! Dependents (not under 14) are encouraged to use the facilities, just as employees.
3) “I read an idealistic scenario. Such a plan is impractical, unrealistic and cost-inefficient. Savings realized from wellness are spent on non-productive bureaucratic structures, administrative/professional fees and costs related to furnishing/supplying the clinics” = WOW, and that was even before I even mentioned how much it cost!!! Sounds like you’re already against it before it starts Bill.
4) What is reasonable hourly rate for NP? For MD? For Wellness Program Headquarters personnel? = Physician supervision PLUS Nurse Practitioner time will vary depending on area in USA, but generally anywhere between $60 and $70 per hour for BOTH. Once the initial visits are out of the way and patients are seen routinely, an average NP will see about 3 patients an hour. Make a quick division and tell me if you think this is inefficient and expensive. “Wellness Headquarters” = This will also vary depending on number of program participants, but roughly $1.25 to $2.00 per program participant per month. (you think that’s an overbloated price and bureaucracy?)
5) Does consumer make appointment? With whom? The clinic or the Wellness Headquarters? = every organization has their own pet way, but the most usual is an open calendar on the clinic door where anyone can walk by and write their name in an (open) appointment.
6) What happens when consumers (employees/ dependants) overwhelm the clinic and staff? = my first question is: what’s the REASON for the overwhelmed appointments? If the visits are episodic and NOT part of a comprehensive chronic risk management program – it’s a waste of time (as happens when you don’t have any control and just leave it as a “free for all”). Every program participant needs to know that the NP is there to manage chronic risk conditions, not runny noses.
7) “Assembly line care, half-hearted consultation” = Wrong. My experience is that NP’s take their job very seriously and like what they do. Because money has been taken out of the equation (they don’t get paid fee for service, remember?) they concentrate on their patient care.
8) “hap- Hazard diagnosis, erroneous conclusions and wrong meds? = Sorry, you can pay as much as you like and STILL run the same risk. This is a hazard when dealing with humans – regardless of the money involved. No guarantees either way. Someone NOT liking the advice can always seek care elsewhere.
9) “OR extraordinary waiting time?” = It’s important to try and estimate the number of hours needed correctly. Wait time? You’re thinking in terms of a doctor’s office! Times are very generously set - more so than in a regular Dr’s office with many rooms and practitioners in a “patient mill”.
10) Who is monitoring NP - Administrative personnel? Bureaucrat? NP? MD? = There are 2 people monitoring the NP. From a CLINICAL perspective, the supervising Dr. The “bureaucrat” makes sure that the NP has all supplies she/he needs and is addressing chronic risk issues at every visit (minimal runny nose cases). It’s important to stay focused and the bureaucrat is there to help keep everything in track from an operational standpoint. You may think management isn’t worth the time of day – if so, I assume you’re not a manager of any kind.
11) Who is “we”? = me, myself and my organization.
12) How were conclusions “found”? = experience in actual settings.
13) In surveys done for the High Deductible Healthcare Plan (HDHP), statistics show that consumers are more prudent
and selective when spending their own money, then they are when having the blank check of unlimited medical coverage. = to me, this is a laughable conclusion – VERY “insurance-like” and EXACTLY how I used to think when I was in the HMO business! At that time, we were convinced that “abusive patients” were breaking the bank and somehow needed to be pushed away from care in order to save money. We feel ENHANCING access to care – not limiting it – is what’s needed to keep chronic conditions in check.
14) In the past, when “little Johnny, or Jeannie” had a sore throat, a “home remedy”, or non-prescription over
the counter medication was given. = Children aren’t even eligible to participate in this program – you’re mixing apples with oranges. Besides, have you ever heard the word “triage”? There are many ways to “filter” the sore throats to a serious condition by trained personnel that are not Dr’s. But in reference to what you’re talking about: there are countless 3rd world countries that have this exact scenario happen daily. If you’re comfortable with the infant mortality rates, so be it. I’m not and consider this an unacceptable level of care.
15) I would like to hear more details regarding the “cost Free” health care and prescription plans. = I meant employees get a PRESCRIPTION for a particular medication for free, not Free medications. Under most plans now, an employee has to visit a Dr, pay the co-payment, take off time from work and THEN pay for the medication.
16) It is also incumbent on the consumer to take responsibility for his/her actions and judiciously utilize the health benefits provided by the employer. = This is so obvious, I didn’t think it had to be mentioned! OF COURSE the employee has to take responsibility! The program allows the company to measure and quantify this. How? By monitoring COMPLIANCE. Without the program, you have no data, no idea what’s going on besides an increase in costs.
17) We don’t need “…multiple "tricks" to get the whole thing to work“ = I have no idea what “tricks” you are referring to. I’m talking about a professional program that contracts with professionals all along the way.
I hope I’ve addressed all your points questions, but if not – please write and I’ll try to address each one.
Raul
From United States, Charlotte
Hello Paladin, Jogeshwar, Rajnish,
I intervene as if company place an active an ongoing health program on basic, primary, preventive and neccessary aspects of employee.
it should reflect in its other costly health covers. there may be some Hi-Fi
who have started to follow than others beating the same bush.
A preliminary and retrospective program is absolute necessary specially heavily loaded and junior companies with very cost effective approach provided they do not think that they have attained or crossed threshold on health index..
Kind Regards
umalme
From India, Delhi
I intervene as if company place an active an ongoing health program on basic, primary, preventive and neccessary aspects of employee.
it should reflect in its other costly health covers. there may be some Hi-Fi
who have started to follow than others beating the same bush.
A preliminary and retrospective program is absolute necessary specially heavily loaded and junior companies with very cost effective approach provided they do not think that they have attained or crossed threshold on health index..
Kind Regards
umalme
From India, Delhi
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