Employer FAQs

How do you manage the prescription drug inventory?

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Our inventory is kept electronically. Prescriptions received by the clinic are recorded in WeCare’s administrative system. When a prescription is dispensed through the clinic, it is removed from the inventory. The medical staff also conducts a weekly physical inventory of the medications.

Can employees communicate with the clinical team?

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If an employee would like to communicate with the medical team directly they may call the clinic with questions. If the medical team is unavailable, they will return the call. We do not recommend email correspondences due to HIPAA.

How do you identify patients with health risks?

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In addition to the Health Risk Appraisal, we identify at-risk patients through:

Medical records,
Pharmacy data,
Utilization Review records (if available),
Case Management records (if available),
A 28 panel lab draw, and
Health risk assessment questionnaire

In addition, we evaluate all available medical and pharmacy claims data using predictive modeling/analytics.

How much does a clinic cost?

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Generally, WeCare clinics cost an employer about $60 per employee per month (PEPM). That break out into two costs. It costs about $43 PEPM to cover all the actual costs of running the clinic, with no markup. These operational costs will vary slightly from month to month. Then we charge a management fee of $17 PEPM that covers the costs of oversight, centralized infrastructure (like information technologies), and a modest profit.

Why are employers implementing onsite clinics?

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Employers invest in clinics to reap returns in their self-funded health plans and through their occupational health programs. So clinics make the most sense for employers who are self-insured, because the savings created by the clinic will accrue directly to them.

But even fully-insured employers will benefit from a clinic. The savings will produce improvements in claims experience that will allow you to argue for premium reductions from your health plan. And you'll save significant dollars in your occupational health programs: workers' compensation, retention/recruitment, occupational health testing and lost productivity.

Would I still need to buy health coverage?

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Most employers do. The clinic provides comprehensive primary care for personal and occupational health issues, but it still makes sense to carry coverage for major medical events.

WHY A WECARE CLINIC?

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PHARMACY

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IDENTIFYING & HELPING AT-RISK PATIENTS

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GETTING BUY-IN & ENCOURAGING CLINIC USE

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APPOINTMENTS

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THE CLINICAL STAFF

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COST

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MONITORING THE CLINIC'S PERFORMANCE

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MAKING THE CLINIC EFFECTIVE

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PRIVACY/SECURITY

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What is the purpose of the clinic?

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To provide employees and dependents (eligible participants) convenient medical services and most prescriptions at no cost to the eligible participant.

Who is eligible for the clinic?

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Employees and dependents identified by your employer as “eligible participants”. These eligible participants are those that are covered under the health plan.

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What services are offered in the clinic?

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Services include but are not limited to the following: Sore throats/ears/headache, strains, sprains, musculoskeletal problems, non-specific abdominal pain, non-specific chest pain, coughs, sinus problems, allergies, allergy injections with patient supplying drug, rashes, acute urinary complaints, personal hygiene related problems, acute injuries, acute routine office procedures, sutures for laceration treatment, routine physical services (including well woman visits), flu shots, occupational medicine, Worker’s Compensation and chronic disease management (i.e. diabetes, high blood pressure, high cholesterol, etc.).

Describe primary care case management.

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Through office visit interviews, the clinic’s primary care physician obtains the patient’s complaint, history and exam. The results may indicate the need for in-office or out-patient tests/diagnostics/radiographs. These may be required in order to obtain the diagnosis and to plan the therapeutic management. In all cases, though, the primary care physician, together with the care/disease management nurse, closely oversee and coordinate all care that is required by any patients obtaining care through the clinic.

Also, the physician will establish the ongoing patient education through initial and follow-up office visits.

Do you stratify members by severity of risk for complication?

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Yes. Our Health Risk Assessment stratifies the participants as qualifying for lower, moderate, and higher relative risk levels.

Are extra communications staff required?

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No additional communications staff is anticipated.

How do you dispense prescription drugs through the clinic?

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Once the employer approves a standard formulary, the medications (excluding narcotics) will be kept in a locked cabinet. Prescriptions are handed to the patient at the end of an office visit, but only after having seen the physician.

When a patient is dispensed a medication included in the clinic’s formulary, the medication is logged into our system and is labeled and signed off on by the physician or nurse practitioner. The patient is given the medication with a fact sheet and the nurse/medical assistant reviews how to take the medication. The formulary can be modified once information about the clinic’s drug prescribing patterns becomes available.

What if a patient is sick and gets a lot worse?

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The clinic’s primary care physician will manage the patient’s condition initially. However, if it escalates beyond his/her scope of practice, the patient will be referred to an appropriate specialist as needed/indicated. (About 8% of patients obtaining care through WeCare’s clinics are referred during the course of a year.) Severely acute conditions may be referred to an emergency department by private (adult accompanied) transport or 911.

How do you handle care for kids?

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Because the needs of children – and especially very small children – are so different, WeCare only provides convenient care for children 2-10 years and routine care for children older than 10 years. We believe children under 10 years should be seen by pediatricians for milestones and other routine care. If the employer provides coverage for a sizable pediatric population, it may be appropriate for WeCare to contract for a part-time pediatrician onsite.

What if the medical team is not available on the day the care is needed?

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WeCare typically establishes relationships with a local “convenience care” clinic for times when the clinic is not open but care is needed. The relationship with a convenience care clinic usually involves preferred pricing and an agreement to exchange the data associated with WeCare patients.

If a patient visits during clinic hours and is triaged as an emergency case, the clinic staff will pre-empt existing appointments and care for the patient.

If the clinic is open but the schedule is full, our electronic scheduler allows patients to get on a waiting list. The medical staff will try to accommodate all patients on the list.

How do you track and document conversations between patients and clinicians.

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The Nurse Counselor documents conversations, which are shared with the rest of the clinical staff through the electronic medical record. The EMR’s Disease Management module communicates directly with the rest of the electronic medical record. Disease management outcome reports are provided yearly and activities reports are provided quarterly.

PATIENT CARE

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PATIENT-CLINIC COMMUNICATIONS

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When will most communications between clinic patients and the staff take place?

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We will communicate with employer’s employees/dependents during clinic hours and sending mailers.

Is your health risk assessment available both on-line and off-line?

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Yes. Our health risk assessment questionnaire is available on-line and on paper.

Can your website be linked with the Employer’s website?

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Yes.

Describe your ability to communicate with an employee population that is geographically dispersed.

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We will ask if we may collaborate with the employer to use its internal communication system, since employees will be familiar with it and it is a system that is effective/working. In addition we can communicate through the News-and-Notices function of WeCare’s Electronic Medical Record. Employee/patients with email addresses recorded in the EMR receive communications electronically. This communication notice precludes transmission of any PHI or PPI.

How often and what type of communications will participants receive from the clinic?

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If a patient agrees to receive information from WeCare, then our Disease Managers/Total Lifestyle Counselors will routinely send health information relevant to the patient’s condition(s). Moderate- to higher-risk individuals may be contacted frequently, as often as weekly. Communications may include telephonic communication and disease specific educational materials sent when appropriate.

How can an employee access your company for Member Services after hours.

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WeCare's corporate office hours of operation are Monday-Friday 8-5PM (EST). An employee may leave a message if after hours. We also have available a 24 hour nurse hotline.

Do you continuously track and work with at-risk members?

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If the patient’s condition is acute, the physician intervenes and manages the patient in an attempt to avoid an acute (and costly) episode.

If the patient has a chronic condition, the clinic’s RN, acting as the Nurse Counselor, intervenes and coaches. The physician works with the Nurse Counselor to assure the patient is informed and engaged in his/her care. The Nurse Counselor promotes compliance by meeting directly with or, sometimes, contacting by phone patients with compliance/high risk behavior issues, and by recommending medical treatments. Customized educational information is sent to patient upon initial assessment and afterward, as patient’s needs are identified.

The Nurse Counselor communicates with the clinic staff through the EMR to assure they are aware of the efforts. The lead clinicians can then reinforce and assist in getting the patient’s buy-in to the goals and objectives of the clinical care plan. The Nurse Counselor continues to assess the patient needs for interventions and provides appropriate interventions and support. She also monitors and coordinates the patients’ care by working with the clinic physician and any specialist involved.

What HRA do you use and how long have you used it?

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We have developed our own HRA and it has been in use since 2005.

How often do you recommend that members have an HRA?

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Annually.

How do you involve new employees in the Health Risk Appraisal (HRA) process?

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When employees become eligible for the clinic, WeCare will collaborate with Employer’s HR to orient the employee. An HRA should also be included in all new hire packets.

How long does it typically take to accomplish the following tasks:

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Providing the HRA results to individuals:
If the HRA is done electronically the results are available within 3 business days over the Internet following the blood draw. If the HRA is done on paper the results are available within 7 business days through the Internet, and by mail within 2 weeks following the blood draw.

Contacting individuals for possible interventions:
For critical labs, the participant will be notified of results within 24 hours. For non-critical labs, WeCare’s Nurse Counsel will connect with the patient within 4 weeks. High-risk patients will be invited to make a follow up appointment in the clinic to go over lab work and risk levels with the physician. However, through the electronic medical record the patient has a visual and printable display of his/her laboratory results within 48-72 hours to share with any physician.

Providing the employer with a summary report of the initial HRA results.
An aggregate report is released within 4-6 weeks after HRA event is completed.

Does WeCare help employees and family members with their HRA questionnaires and in the interpretation of their personal profiles?

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WeCare corporate and medical staff will be on-site for the clinic’s opening and will be able to walk individuals through the completion of the HRA questionnaire and interpretation of their personal profiles. An 800-number customer service line is also available to answer questions about the completion of the HRA or the profile. We encourage completion of the HRA/lab process within the first 2 weeks of opening of the worksite clinic.

What level of participation can we expect in the clinic's first three years?

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50% is a reasonable goal for year one, but incentives can increase this number. In WeCare’s clinics, we have typically seen 66% participation by the end of Year One. Participation in Years Two and Three are also dependent on communication and incentives and we have seen as high as 90% with significant incentives.

How will WeCare work with us to set and reach participation goals?

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We recommend that incentives be provided. In our experience we have seen that participation levels are drastically increased based on the incentives provided.

Do you recommend using incentives?

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Absolutely. Some suggestions are a credit toward a deductible, cash cards or gas cards. Talk with us about this.

How do you link to on-site or community programs (e.g., Employees Assistance Programs, Wellness Screenings)?

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Once we determine the programs through the Employer’s benefit program and available within the community, we will collaborate with the Employer to identify the best way to making employees and family members aware of all available services. The clinic staff will be educated to assure all of the services are communicated appropriately and as needed.

Why kind of clinical interventions and education do the clinics provide? What results do you get?

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Communication is on-going with the clinic medical staff and the Nurse Counselors to provide continuity of care and compliance. With each visit the patient is given discharge information, and education concerning chronic conditions or acute situations as presented. Following each visit a follow up call is made to the patient to assure understanding of material covered during previous day’s visit. With each visit the patient’s progress is tracked electronically so that the patient can see his/her improvement. The EMR also graphs certain clinical indicators over time so the patient can view the information. This information is shared electronically with the TLC who reinforces the teaching. WeCare’s clinical staff may also contact a patient’s network physicians as needed.

How do you measure the outcomes and success of the overall program?

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Ultimately, the impact on the plan’s claims experience provides the best indicators of the program’s performance. WeCare’s reports track improvements in risk categories and behaviors. Once your historical claims data is available through the data warehouse benchmarks will be established for targeted improvement. Areas targeted include primary care, specialty care, laboratory, and Rx costs.

Do you issue standard management reports? What about custom reports and their associated costs?

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To the extent that the data elements are captured, any custom report requests by the employer are available at no additional cost.

How does WeCare evaluate the effectiveness of its primary care case management?

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An excellent indicator of effectiveness is the percentage of moderate and high-risk individuals that are active clinic patients and are actively involved with the WeCare program.

Through quality assurance audits the medical provider is evaluated against embedded standards of care. The provider’s performance rating is utilized to conduct any additional training needed.

What indicators do you use to track the clinic's impact?

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Program Outcomes. These are measured by service type (Medical, HR/Occ, and Worker’s Comp). They detail and summarize the number and type of visits, compared to their cost outside the clinic. All modalities utilized in the clinic will be included.

Utilization Measures. Utilization is measured by the number of visits utilized versus visits available as well as percent of the employee and dependent population utilizing the clinic.

Member Satisfaction. Member satisfaction is tracked through our quarterly random satisfaction survey, as well as those surveys offered to and completed by clinic patients at the time they are seen, and those available to be completed on-line at any time the member so desires.

Changes in the Cost of Care. These can be measured by dollars saved by the visit occurring in the clinic as compared to the health plan, or by the decrease in medical trend if the clinic had not been in place and, hopefully, to the decreasing cost of the health plan on a per employee per month basis.

Productivity/Absenteeism. These numbers are usually tracked through the HR department. If we can work with them directly, we can correlate health impacts effected through the clinic to changes in absenteeism, presenteeism and productivity.

How are records managed for individuals with both personal health and job injuries.

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WeCare’s EMR captures the reason for each visit (Medical, Worker’s Comp, HR/Occ), and although it is one complete record when viewed by the clinician, it can be printed by visit type, so that only personal health or the worker’s comp visit data are shared.

Can you update a patient’s medical record while conducting follow-up calls?

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Our system is totally integrated. Our Nurse Counselors and On-site medical staff communicate via the Electronic Medical Record, giving all clinicians the ability to update the patient’s record at any point.

How do you engage patients who have conditions that need attention?

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Individuals identified with moderate and high-risk conditions are contacted by the Nurse Counselor and invited into the clinic. The physician and the Nurse Counselor work to ensure patient compliance with medical treatment plan. Educational information is provided to patient according to the pertinent risk categories identified. If the Nurse Counselor fails in her efforts to engage the patient, she may ask the physician to reach out to the patient.

What if you can't reach the at-risk patient?

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We use all contact methods authorized by the patient (i.e. mail, internet, and phone). The Nurse Counselor will also call at night or on weekends if that is what the patient prefers. In addition, because the Nurse Counselor’s notes appear in the clinic EMR, the clinic staff will engage the patient when they are seen in the clinic. The Nurse Counselor may also request the clinic staff to reach out to the patient.

Where do you get support materials for patient education.

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Educational information is provided by national health organizations.

How does your HRA monitor and report individual changes from year to year?

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The individual HRA report in subsequent years will identify lab results for each preceding year. The patient can view or print each year electronically (by the participant, the clinic, or Nurse Counselor for the participant). The employer receives an aggregate report that shows a side-by-side comparison by year.

Do you offer online scheduling?

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Yes.

How are appointments scheduled?

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Appointments may be scheduled electronically by the patient, through an 800 number and/or by calling the clinic directly (if allowed by employer). If employer would like employees to have the opportunity to call the clinic to make appointments directly, additional clerical staff will be necessary.

How many appointments per day can you handle?

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We expect an average of 2.5 appointments an hour per lead clinician, with 30-40 minutes for new patient visits and 20 minutes for established patients.

Have your IT systems ever been breached?

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To our knowledge our systems have never been breached.

Is the personal health data in your system secure?

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Every user must authenticate through a log-in and password. Our system is an encrypted, secure website with automatic time outs. Also, our servers are housed in a locked secure location with all of the servers sitting behind firewalls. We have taken steps to safeguard against security breaches by contracting with a security specialist company (Security Innovations) that has worked through our site to identify vulnerabilities which have been addressed and we did receive certification in September 2007. As another layer of protection, we have McAfee Hackersafe Intrusion protection software monitoring our site real time for potential new vulnerabilities as the hacker industry becomes more sophisticated.

Is WeCare HIPAA compliant?

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WeCare strictly adheres to HIPAA’s privacy and security regulations, establishing a firewall between the employer and the clinic’ information about each patient. WeCare considers these critical elements of our program that cannot be breached. Security levels are built into our electronic medical records software to meet all appropriate confidentiality Policies and Procedures, State and Federal laws and regulations in compliance with HIPAA. Access to a patient’s medical record is treated with utmost respect and confidentiality. Access to both paper and electronic medical record is limited to only those staff with actual need. Access rights are audited on a routine basis and use assignments reviewed and corrected. Staff with access to the automated medical record will be trained in the standards and behavior incumbent with this privilege.

Will our physician(s) have hospital privileges? If so, where?

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Our physicians may or may not have hospital privileges. Typically, WeCare collaborates with staff hospitalists at local facilities on the employers’ health plan network. WeCare’s primary care physician may defer admissions to the scheduled hospital ‘on-call’ physician, and the hospitalist follows the patient in the hospital. Release of hospital admission records will be requested after patient discharge for continuity of care.

Do you use a doctor or a nurse-led model. Why?

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WeCare clinics use a physician-led care model. The goal of this arrangement is to make the clinic the medical home for most employees and their families, and by doing so provide superior care at lower cost than is typically available through the health plan network.

Besides the doctor, who else staffs the clinic?

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In the most basic arrangement, the physician is supported by Nurse (RN) Counselor, who provides one-on-one lifestyle management coaching to patients with chronic disease, and by a Medical Assistant, who assists the physician and helps manage the clinic's day-to-day operations.

What does it cost for the medical staff?

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WeCare believes that it makes sense to pay primary care physicians (PCPs) well, and get very good ones. We usually pay about one-third more than a PCP can make in private practice, and we pay our other medical staff slightly better than market as well. We firmly believe these investments are more than justified by the enhanced quality and significant savings these professionals can produce.

What are the costs for employees to use the clinic?

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This is no cost to employees to use the clinic.

How many employees does it take to justify a clinic?

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Clinics are scalable, and make good financial sense at almost any size. For each clinic, WeCare typically requires at least one “anchor” client with 250 or more employees. After that, other employers can join in collaboratively to increase the clinic's use.

How do you ensure the confidentiality of caller information?

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We follow HIPAA standards for patient confidentiality. Our scheduler requires the patient sign in with a confidential password. Clinic staff access to the EMR and Scheduler is password-protected and our system has been certified as safe by Security Innovation and McAfee Hackersafe. All the clinic staff sign confidentiality agreements.