Johns Hopkins Medicine On-Site Employee Health and Wellness Centers has provided on-site health care and wellness medicine services for over sixteen years. The Division has a growing number of employers with work-sites in over eighteen (18) states. (see graph)
These centers provide another level to manage medical costs by focusing on:
- Front line assessment and treatment of injuries / illness
- Delivery of wellness and prevention services
- Development of local health care strategy
- Support of safety initiatives
- Selecting, credentialing and providing malpractice insurance for mid-level providers (NPs/PAs)
- Insuring the continuous provision of high quality medical care
- Providing ongoing assessment of cost benefit ratios
Electronic Patient Record System Recruitment
Johns Hopkins has an extensive nurse practitioner and physician assistant recruiting network. This network identities mid-level providers with strong clinical and excellent interpersonal skills. Successful candidates are then interviewed by the client to determine if the provider is a good fit for the organization. Once this has been established, the candidate who meets the standards set by the client and Johns Hopkins is hired and trained in occupational care management techniques.
Johns Hopkins insures that all mid-level providers practice high quality medical care through the use of a proprietary program within an electronic patient record (EPR) system to do so. All diagnostic and treatment data generated by the mid-level providers, such as clinic notes, treatment plans, etc., are entered into the EPR as patients are seen. A subset of this information is abstracted daily and reviewed by practitioners at Johns Hopkins. Any deviations from accepted medical practices are flagged and mid-level providers are informed of these immediately and corrections to their practices are made. In the nine years Hopkins has been using the EPR System, there have only been a handful of instances where an improvement clinical care could be made.
Assessments of Benefits to Clients
To access the cost benefit ratio or return on investment (ROI) of on-site occupational medicine services. Johns Hopkins has created a web based platform that continuously monitors each mid-level provider's performance in this domain. This web interface is imbedded into the electronic patient record software and ROI calculated as patients are seen. Each of its clients utilizes a slightly different approach to calculating the ROI. However, the common feature of all calculations revolves around the difference in the expense of the on-site mid-level provide versus the cost medical services in the local community. These data are reviewed monthly to determine how success for the program is in reducing medical care costs for the client.
Services - Customized To Each Client Needs
- Advise and treat non-occupational and occupational illness and injury (non-life threatening).
- Provide referrals to primary care physician or specialist as needed
- Provide general medical advice to the patients as needed
- Provide crisis management, intervention, or dispense mediation as needed
- Write prescriptions as are needed
- Provide patient support and patient case management for illness and injury
- Coordinate second opinions for employees absent due to illness, workers' comp or disability
- Coordinate and plan health education seminars and general wellness events to include exercise programs, lunch and learns, newsletters of health fairs
- Perform on-site physical assessments as required by employer
- Monthly ROI calculations and analyses
- Dispense over the counter and prescription medications with pre-established standing orders as needed
Return Investment Analysis
- The mid level provider inputs the employee visit date in the electronic medical record system, capturing visit date, visit type, encounter type, and intervention type.
- This information is transmitted and saved in a data warehouse, where batch-job query procedures run based on defined criteria and feed into a customized template worksheet.
- Once the visit activity is summarized based on the specified criteria, the results are grouped and costs assigned based on the type of encounter or visit transmitted and supplies into a report for management presentation purposes.
- The report calculates a client's site ROI based on the operational costs of the site and the cost savings.
- For example, depending on the "Drug Testing" encounter type (i.e. random), a pre-defined savings for collection fee is defined using a $33 as national average. The cost savings is multiplied by the quantity of encounters deriving a total cost savings for the occupational visit. Once all the occupational health encounter-type total cost savings are summarized (i.e. labor savings), the report calculates a ROI based on the cost of an employee using the on-site location versus an off-site clinic.
A Statement From Ed Bernacki, MD, MPH
We add value to employers because employers pay the healthcare costs and salaries of their employees. We treat illness and injuries in an expeditious manner which decreases healthcare costs to the employer (and employees, if they pay for a portion of the premium) and reduces the amount of time away from work by employees for illness related absences.
The return on investment (ROI) for our service is greatest when we care for 400 or more working aged individuals (employed by one or more employers). Traditionally we have offered our services to single employers, but believe that our model of care will work equally as well with a number of employers utilizing an onsite clinic proximate to their work places. The ROI is the highest, of course, if the employer pays for health and disability insurance, as well as workers compensation. It can also be of tremendous assistance to employees who pay for much of their medical insurance themselves (i.e., they save the money, not their employer) or employees who are between plans.