In 1992, Lilly’s Corporate Health Services (CHS) was formed combining the administration of all domestic on-site medical facilities, Employee Health Services (EHS) and the Lilly Health Plan (LHP). The goal was to identify synergistic opportunities which would enhance the health of health plan members and improve the health dollar efficiency by challenging traditional barriers and practices.
Program Description
Narrative Description of Program
In 1992, Lilly’s Corporate Health Services (CHS) was formed combining the administration of all domestic on-site medical facilities, Employee Health Services (EHS) and the Lilly Health Plan (LHP). The goal was to identify synergistic opportunities which would enhance the health of health plan members and improve the health dollar efficiency by challenging traditional barriers and practices.
Lilly’s on-site medical facilities, in addition to occupational health services, provide a full array of adult ambulatory health care needs, whether the treatment intervention is work related or personal. Annually over 60,000 personal care (non work-related) visits are delivered.
In addition, on-site nursing mother stations, mammography, community based screening colonoscopy, physical therapy and laboratory services are readily available for employees (regardless of managed or indemnity plan membership) with no “co-pay” and direct health plan billing to reduce administrative complexities.
90% of Lilly’s active employees elect to participate in EHS’s preventive health (StEP) exam, the frequency and content of StEP are adjusted for age, gender, job activity and known personal health risks (Item A). This program is uniformly offered regardless of salary class.
Recently, CHS assumed coordination of all work absences to better assure appropriate benefit delivery and regulation compliance.
By increasing medical access, expanding preventive care services and minimizing administrative barriers, reduced health risks and costs are experienced.
Contact Summary
| General Information | |
|---|---|
| Program Name | Corporate Health Services |
| Company Name and Address | Eli Lilly and CompanyLilly Corporate Center, DC 2111Indianapolis, IN 46285 |
| Contact Person | Gregory N. Larkin, M.D.Director, Corporate Health Services |
| Program Information | |
| Program Category | Worksite, High-risk, Chronic disease, Insurance, Integrated Systems of Care |
| Year begun | 1992 |
| Total number of individual participants | 12,000 |
| Number of currently actively enrolled | 12,000 |
| Access to Program | Employees, Family members, Retirees |
| Estimated cost savings per participant per year | +/- $400.00 |
| Data available to external reviewers or investigators | Yes |
| Program targeted at Healthy People 2000 goals |
Yes |
| Program goals (in priority order) | (1) Health Risk Reduction(2) Quality Healthcare(3) Health Cost Reduction(4) Increased Productivity |
Evaluation Summary
CHS’s array of programs and services demonstrate effective risk and cost reductions. On-site contracted mammography studies are less per unit than if delivered in the community and the detection rate meets or exceeds national standards (0.43% detection rate) (Item B). High user satisfaction and low complications have consistently been recorded. In the first two years, Lilly's innovative screening colonoscopy program has detected and removed 414 cancerous and cancer-prone lesions (Item C).
All on-site medical visits are routinely coded for procedure and diagnosis. If compared to community procedure pricing and health plan reimbursement practices, the professional EHS personal care charges, if billed, would generate a department income equal to the total operational budget for all corporate global services of CHS. Also, by leveraging the access to our large population, and streamlining administration, negotiated costs per mammogram and colonoscopy are considerably reduced while providing a higher level of service (Item D).
Per evaluation by an external consultant when applying actuarial and geographic metrics, the costs and number of community based medical services are less than expected in the Lilly population. This is attributed to, in part, by the aggressive preventive health programs (e.g. StEP, mammography, colonoscopy), and the on-site services for Lilly employees and retirees (Item E).
Although coordination of work absences is a new service (started in January, 1998), planned lengths of absences have been reduced with assistance and clarification provided to the patient and provider by CHS.
This new program “Return to Work Coordination” has evolved over 12 months of planning to assure understanding and cooperation of the employees and line management. Within five days of absence, the RTW coordinator provides benefit administration information to the patient, and provider. In absences that appear atypical, EHS physicians or psychologists will review the case with the patient’s provider. Where care plans, quality of care or length of absence is debatable, EHS can arrange for a second opinion from a qualified community based physician prior to interrupting benefit delivery.
CHS designed and negotiated Lilly’s uniform rich managed (POS-HMO) benefit which is delivered by four managed care organizations (MCO). Without any significant financial enrollment incentive, 40% of the Lilly eligible population elected managed care. By requiring the MCOs to credit Lilly for EHS provided services, the attributes of on-site health care, and innovative preventive care is uniformly delivered to all employees without duplicating costs for the EHS services and the capitated (prepay) managed care premiums for similar services.
Critique
The Corporate Health Services program was formed in 1992 to identify synergistic opportunities which would enhance the health of health plan members and improve the health dollar efficiency by challenging traditional barriers and practices. 90% of active employees elect to participate in preventive health examinations. By reducing medical access, expanding preventive care services and minimizing administrative barriers, reduced health risks and costs are experienced.
Specific Comments Included:
The program targets family members and retirees as well as employees and includes quality health care as a goal. It targets high risk individuals. It manages both employee health services and the health plan as a single entity. This is a “on-site clinical services” approach. There is a traditional medical model for preventive services with good mammography and colonoscopy programs. There is an interesting financial reimbursement arrangement with HMO’s. The program has good framework and direction. Health professionals customize the follow-up programs. There is excellent coordination of interventions with health plans like Community Primary Care Providers.
Reservations Included:
Savings are based on the amount spent as opposed to what would have been spent if individuals sought care from a community provider. There is no real analytic or study design. This is not a health risk reduction program. Primarily, this is an enhanced managed care program. No solid costs-per-participant information are availabel and there has been no direct attempt to determine an ROI. The emphasis on preventive health services is not necessarily cost-effective, although it has merit. There is no self-care component or low birth weight reduction program.