C. EVERETT KOOP NATIONAL HEALTH AWARDS

Eli Lilly and Company 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.