Blogs by Jennifer Austin

Jennifer Austin

Director, Marketing and Product Development

Jennifer Austin joined The Alliance in mid-2019, leading the team in managing marketing efforts, including brand strategy, paid advertising, publication relations, social media, and website development.

Before joining The Alliance, Jennifer worked at a number of companies in Chicago and Madison focusing on marketing and strategy development for hospitals and health systems, including Advocate Healthcare (now Advocate Aurora Health), Augusta University Health, and HCA Healthcare.

Jennifer has a master’s degree in Global Marketing, Communications and Advertising from Emerson College and a bachelor’s degree in Art and English from The University of Iowa.

 




This is a blog recap of our virtual event, The Alliance 2021 Spring Symposium, held on May 6. Click here to view the recording and for more Employer Resources. 

Cheryl DeMars, CEO of The Alliance, kicked off the event by illustrating how the rate of medical inflation is outpacing all other inflation. The graphic she referred to shows that medical expenses have increased by 225% over the past 20 years while wages only increased 75% during that same span. 

“Health care is eroding our ability to pay for other things that contribute to the health and wellbeing of our families,” she concluded. 



This was meant to set the stage for the rest of the day and Cheryl then introduced Dr. Marty Makary, the keynote speaker. He jumped into his presentation by explaining how he’s optimistic about the future of health care – especially for employers.  

“I’m a big fan of The Alliance. You’ve done a terrific job,” he began. “The patient is fed up with the current system, and nobody really advocates for the consumer except for employers. We’re the voice for the voiceless. There is a profound enthusiasm to redesign a better health care system and its being driven by employers. Keep up the advocacy, it’s important and we need it.” 

Further, he explained that 88% of Americans agree on wanting transparent prices. “Health care transparency is bipartisan. We got the transparency rule and now we’re working on compliance,” he said, referring to the Hospital Price Transparency rule. 
The Voice for The Vulnerable 
Dr. Makary briefly recapped the history of modern medicine and how the medical field has long stood up for the vulnerable by explaining how America’s first hospital, Pennsylvania hospital, had a mission to take care of anybody – regardless of race, citizenship, or their ability to pay. 

“We’re in a very different position today,” he continued. “We spend $16 billion on measuring outcomes. We’ve got a cost crisis that’s spinning out of control.” 
An Appropriateness of Care Crisis 
Dr. Makary suggested that the health of a population is one of the highest costs. “The United States is the most obese, most overly medicated population in the world. Ten years ago, we prescribed 2.4 billion medications. Last year, we prescribed 5 billion. Disease hasn’t doubled – we have a crisis of appropriateness. Appropriateness is the leading issue in health care that we’re not talking about, but that we need to be talking about.” 

Currently, we measure health care quality in terms of the outcome only, said Dr. Makary. For example, 75% of patients with appendicitis could be successfully managed with antibiotics alone. “That’s earth-shattering in an area where everyone is trained to treat it with an appendectomy. Not only does it reduce the number of opioids prescribed, it has implications for cost, hospital utilization, and the waitlist schedule.” And it all adds up to an overworked, wasteful, and inefficient health care system. 
The Direct Primary Care Solution 
Dr. Makary explained how the appropriateness problem could be solved:
by addressing underlying issues rather than reacting to symptoms. “We’re consistently looking at drugs rather than underlying causes, and what we’re discovering, in terms of primary care, is that those who spend more time with their patients address those underlying causes and have better outcomes.”

Direct Primary Care, for example, forgoes the traditional fee-for-service payment model, often using a monthly fee for unlimited access, to produce closer primary care relationships that better benefit patients. In his words, “when you get people off the fee-for-service treadmill, amazing things can happen.” 

He then ran through examples of how physicians administer appropriate care after spending more time with their patients: 

High blood pressure addressed by monitoring sleep and stress levels rather than just prescribing hypertension medications.
Diabetes treated with cooking classes rather than simply prescribing insulin for the rest of their lives
Back pain treated with ice and physical therapy rather than surgery and opioids. 

The Price We Pay 
Next, Dr. Makary moved on to the topic of cost. He put it simply: people don’t understand how much money is going into health care. And it’s a lot. 

“We’re all paying in different ways because health care has many hidden costs.” He said while pointing out a pie chart displaying the US federal spending makeup, which showed that 25% of our federal budget goes towards Medicare and Medicaid. However, suppose you take into account the amount of money that social security uses towards medical care, the amount the Department of Defense (DoD) uses on their health care system, the amount Veteran’s Affairs (VA) spends, the interest on the health care spending debt, and what we pay for federal workers’ health care benefits, the actual amount of federal spending on health care is actually closer to 48%.  

He bolstered his statement by explaining how the average family spends roughly $20,000 per year on medical expenses, which does not include what employers are paying for them. 
“And after all that spending, folks are told that their care isn’t covered,” he said. “People have a right to be angry.”  
The Future of Price Transparency 
Dr. Makary then explained that improved transparency produces lower costs for employers and consumers. “The reason price-gouging happens is because you are never given a price – even for ‘shoppable’ procedures.”

He then compared hospital pricing to airline pricing. “Imagine you’re buying a plane ticket, and the airline says ‘we can’t give you a price because we don’t know what the flight will cost us. We don’t know if there’s going to be a delay, cancellation, or if the pilot will experience turbulence.’ And then, after the flight, you’re billed separately by the pilot, the airline, the stewardess, and Coca-Cola for the marked-up soda you had on the plane. We can do better.” 

Next, he provided a story about a researcher who called 100 different hospitals requesting a cash price for a standard procedure. “Only half of the hospitals gave him a price after haggling, calling back, and sometimes escalating the issue to the CFO. The hospitals that provided prices ranged from $44,000 to $500,000 for the same procedure.” 

Further, the highest cost estimates did not belong to the highest-quality hospitals. “[This procedure] has the most mature quality registry in all of health care,” Dr. Makary explained. “They have all their outcomes independently assessed by a nurse reviewer and then submitted to the Professional Society of Thoracic Surgeons.” In other words, there was no association between quality and price. Dr. Makary’s team also found no association between the cost estimates and the amount of charity care each hospital produced. 
Good People in a Bad System 
“We have a great medical heritage and need to maintain our public trust,” said Dr. Makary. “Price-gouging and predatory billing is threatening that trust.” He supplemented his statement by referencing a 2019 JAMA study that discovered a single community hospital in Virginia (in a town of 30,000 people) had sued its patients over 25,000 times. The most common employer for those patients? Walmart. That means, in Dr. Makary’s words, “they’re not deadbeats… These are people living paycheck to paycheck.” 

He concluded his statements about price by saying he doesn’t believe any “diabolical” individuals are to blame. 
“There aren’t bad people in health care. These are good people working in a bad system… the system is broken... As we continue to blame, we continue to make mistakes.” 
Employer Guidance 
So what can employers do? According to Dr. Makary, “we need more boldness when it comes to creative benefit plan design. There’s a reluctance to innovating health benefits because there’s a misconception people are getting a good deal.” On the contrary, he pointed to RAND Corporation’s findings that commercial plans pay 247% more than Medicare, on average. 

“Employers are the most exciting area in all of health care,” stated Dr. Makary. “Talk to multiple benefit designers and strategists instead of just one, then find and talk to people who have used that PBM or health plan, etc. Then get creative with new relationship-based products. There’s a lot of great innovation out there.” 
Content Expert Question-and-Answer Session 
And to talk about that opportunity for innovation, a panel of data consultants were asked to answer top employer questions. This session was moderated by Melina Kambitsi, Ph.D., SVP of Business Development and Strategic Marketing at The Alliance. An abridged version of the following content experts’ answers is below. 

Gerald Frye – CEO, The Benefits Services Group  
Sarah Delaney – Vice President, Analytics Services, Marsh & McLennan 
Sara Hames – Consultant, NBS Advisors, LLC  

 

Melina: We know health care is expensive, so based on your work, can you describe strategies to make health care more affordable for their self-funded plan and its employees? 
Jerry Frye:For employers to reduce the cost and improve quality, they need to understand the appropriateness of care. On a macro basis, only 17% of the total cost of care is influenced by prices. The other 83% is appropriateness, efficiency, quality, etc. So it’s important to have ways to measure those. 

But most of the reporting you get from the major carriers isn’t showing the continuum of care. When you actually look at the efficiency of individual providers, the pharmacies are calling the doctor’s office to get an insulin refill. 67% of the excess insulin being delivered is due to a lack of primary care relationship with the patient.

Episodes of care also allow you to benchmark considerably differently. We can’t just beat the other guy by a little bit. The system is broke, so you need to start benchmarking. You take these episodes, grade them on how well they were performed, and assess them. 40-60% of these episodes are terribly inefficient. In a $20 million spend, you’ll find that $8 million of it is inefficient. We can’t afford average – you have to get the best care price.

 
Sarah Delaney: Bringing in a clinical expertise. We’re looking at claims data to identify inappropriate utilization. We’re tying together all the pieces of data together and focusing small. It’s one piece. You don’t have to find the right answer; you have to focus on where the data is actually driving things.
Sara Hames: If you’re not working with a transparent partner like The Alliance there’s a definite lack of actionable data. What’s the member spend? Our average workforce cannot afford it anymore. Employers need to recognize their employees are not getting the care they need because they can’t afford it. Afraid of surprise medical billing? One of the solutions is finding that strong primary care relationship and making it very affordable to your membership. Find that provider who will take the time with patients, treat them, and keep them from being transferred to a system they will be lost in – and get flooded with bills. People need to go to get the care they need without worrying about affordability. 
Melina: How do your employers encourage your employees to make better health care decisions? 
Sara Hames: The best way to do that is to create those choices for them. Tell them what’s a smart choice. The member cannot navigate the landscape on their own. The tools out there are inaccurate and complicated. Tell them where they can go and incent them to go – make it free or low-cost, which will be even more impactful. 
Melina: Can you ever be looking at too much data? 
Jerry Frye: There’s no end to the amount of data available. What employers need is actual intelligence which is data put into the proper context within the strategic plan of what the employer is trying to accomplish. A 70-page report isn’t going to help without actual synthesis. Give employers the two, three, or four nuggets that they should focus on. 
Sarah Delaney: You can sometimes get information paralysis. You just have so much information you don’t know where to start. That’s where employers struggle. They go through a 30-page report in two hours that’s boring demographic information. Our job is to take data and make it information. What are the five bullet-points? What do I need to change and how can I change it?  
Melina: How are you addressing the cost challenges of non-compliant patients? 
Sara Hames:Primary care. Having that dedicated primary care agent is huge. Having direct contracts for bundled payments, and a 2nd aspect that focuses on patient compliance as the patient goes through the journey, they’re incentivized for following through on what they’re supposed to do. One suchorganization had 98% compliance which is amazing. If you coach patients along and help them do what they’re supposed to do, it’s much more likely to happen.

Sara Delaney: We have a case study of a 500-employee group that were was doing biometric screenings, and they stopped offering them when they noticed primary care visits decreased. So they dropped them and instead are incentivizing primary care visits. As a result, they’ve seen a 25% increase in primary care visits, 10% decrease in ER utilization, and cancer screenings are now 10-15% better than benchmark. 
Jerry Frye: This starts with primary care. Then you need to have the right network for referrals. Then you need some form of coaching, advocacy, navigation, etc. to help the employee. There has to be some connection to the health provider to act as a resource for the consumer. Poor adherence is often due to ignorance, and this would help with that. 
Melina: What are the pros and cons of primary care relationships in states where most hospital systems are extremely consolidated? 
Jerry Frye: Wisconsin has more integrated care systems than any other state. We also have the highest concentration of provider-owned health plans. This is a common problem in Wisconsin. The primary care needs to be held accountable to best-practices because the health system is going to try to steer all their care internally. Its very difficult to do Direct Primary Care in Wisconsin. You have to work with someone like Sara Hames, Sarah Delaney, or us to get there – because the health systems make it very difficult to get there.
Sara Hames: Direct Primary Care is coming back; 80% of doctors working in health care systems are not happy doctors because they don’t get to spend the time with their patients. They become revenue generators which goes against their education, and they just want to get back to treating patients. The independent relationship gives people a different perspective. Direct Primary Care is coming back – The Alliance is focused on that. Most of my clients have their own employer-sponsored clinics. If you spend time on it and do it right, they can be amazingly successful. Better outcomes, lowered costs, and higher patient appreciation, talent acquisition, and employee retention.
Sarah Delaney: The reality is that this is a systemic problem. Pushing for quality of care and data is the only way to change their payment methodology. It’s a slow burn, unfortunately. At the end of the day, fee-for-service has to go away at the physician level. 
Melina: The size of the average employer at The Alliance is between 170–200 employees. How do small employers get their data? 
Sara Hames: The size doesn’t matter, the partners do. You’ve got to look at health care differently. Say you’re The Alliance and have 50 employees on your self-funded plan; if you steer to the right providers you can improve things. Be bold. Think differently. What are the problems? What can we do to solve them? Push your broker to push the insurer to get your data. 
Melina: Yes, The Alliance currently has 40 employers using QualityPath and 60-70 actively steering their employees using The Premier Network. Do you have any final thoughts? 
Sara Hames: But that’s important! It takes a lot of work to get all those contracts, so thanks to The Alliance for doing that because it’s good for everybody. 
Jerry Frye: Regardless of size and access to data, get the primary care relationship set. Then get your employees information on where to be referred to. Then coach them or navigate them. If that person is informed with the right information, they’re likely to make the right choice. By the way, that’s what The Alliance does best! 
Sarah Delaney: The important thing is holding your vendors, partners, and employees accountable. Get the right partners and get the data you need. Help steer your employees in the right direction but giving them the tools and education to help them make the right decisions. 
RAND Corporation’s Hospital Price Transparency Project 

Cheryl closed out the event by urging employers to participate in RAND Corporation’s ongoing health care price study, which acts as an independent, objective data resource for employers and enables them to: 

Be better-informed shoppers of health plans and health care 
Hold hospitals, health systems, and health plans accountable for the prices they have negotiated 
Report hospital prices relative to a Medicare benchmark 

RAND uses claims data from multiple resources, including self-funded employers, to create a public hospital price report that’s freely downloadable. They name facilities and systems and their inpatient and outpatient hospital prices. 

“The Alliance is digging into the information we received from RAND’s 3rd round to control prices while ensuring quality of care. We’re only beginning this work,” said Cheryl. 

To participate and obtain your private report – which shows the actual allowed amount you paid, the relative price paid by other organizations in your area, and more – please email Brian Briscombe (bbriscom@rand.org) and confirm your insurance carrier (or data warehouse) by May 28. 



This is a blog recap of a virtual event held on April 26. Click here to view the full webinar recording. Click here to skip to the Employer Resources section.  

To begin the webinar, Kyle Monroe, Vice President of Network Development & Provider Relations, explained that The Alliance is placing added emphasis on behavioral mental health during the pandemic, and as a result, has contracted with over 110 behavioral mental health providers (850 clinicians) over the past year alone. What’s more, all of those contracts are based on a percentage of Medicare using Reference-Based Contracting by The Alliance. Kyle then introduced Dr. Jerry L. Halverson, Chief Medical Officer at Rogers Behavioral Health, to discuss data points employers can use to improve their awareness and mental health offerings. 
Why Mental Health Matters for Employers 
Dr. Halverson began his portion of the event by highlighting why behavioral mental health matters to employers: 

Mental health costs employers $500 billion/year due to disability, absenteeism, presenteeism, lost productivity, and more. Mood disorders are the most common cause for hospitalization in the US for people under age 45, and more than 17 million people had at least one major depressive episode over the past year.
Last year, 1 in 5 people experienced a mental illness, 1 in 10 experienced a substance abuse disorder, and 1 in 20 had both. (Almost 74% of those with a substance abuse order struggled with alcohol addiction.)
Mental health treatment is effective, but many don’t seek it. 60% of adults with mental health illness did not receive mental health services in the previous year, while 80% of individuals with depression, when treated, fully recover. Pursuit of treatment is lacking due to a variety of reasons including stigma, cost, and loss of job (and subsequently health insurance).
Further, people seeking treatment face barriers in accessing providers due to facility closures and a shift from in-person care to telemedicine care – which, as Dr. Halverson explained – is not always the best choice for every mental health disorder. 
When treated, 86% of people report improved work performance, 80% report “high levels of work efficacy and satisfaction,” and 40-60% report a significantly reduced rate of absenteeism.
Mental illness can impact physical health as well, increasing the risk of heart disease, stroke, diabetes, and some forms of cancer. As self-funded employers know well, these risks can be costly down the road if not prevented. 

The COVID-19 Effect on Mental Health 
Dr. Halverson described mental health as a “second pandemic” and referenced a July 2020 Kaiser Family Foundation (KFF) report’s findings: 

53% of adults experienced negative mental health effects due to COVID-19. 
36% experienced trouble sleeping
32% had difficulty eating
12% increased their substance use
12% experienced a worsening in their existing psychiatric issues 

He then offered an even larger concern, citing a June 2020 CDC study in which 11% of U.S. adults reported they had seriously considered suicide over the past 30 days. 

Using that same study, Dr. Halverson showed that non-whites, essential workers, and young people (especially those aged 18-29) were disproportionally more affected by the pandemic than other groups. 
How Depression, Anxiety, and Addiction Present Themselves at Work 
Dr. Halverson then went through the variety of ways that depression, anxiety, addiction, and other mental health issues can crop up in the workplace: 

Withdrawal from team socially, secrecy, and isolation
General indifference
Missed deadlines
Increased rate of accidents
Seems “scatterbrained” or absent-minded
Procrastinates or is indecisive
Increased tardiness/lack of attendance without advanced notice or doctor’s note
Unsure of one’s abilities or lack of confidence
Low motivation/detachment
Inappropriate behavior and changes in mood and personality
Change in appearance and poor hygiene 

What Employers Can Do to Improve Employee Mental Health 
Dr. Halverson then provided some strategies employers can use to help improve mental health in the workplace. Employers can design their health benefits to include medical, mental, and prescription benefits, in addition to choosing health and wellness vendors, EAP services, and other worksite programs that offer additional mental health services. 

Employers can also work towards reducing the negative stigma associated with mental health disorders by creating a culture of holistic health, offering support for those who seek it, and increasing the overall awareness of mental health issues and the benefits offered. 

Other ways employers can influence mental health include: 

Encourage employees to use their benefits, including paid time off.
Educate employees and management about mental health conditions.
Encourage employees to seek help when they need it.
Integrate mental health information and resources into regular company communications. (Include it into newsletters, company intranet, and other regular communication vehicles.)
Promote the recognition of mental health issues. (8 in 10 people considering suicide give some sign of their intentions.)
Lead by example; follow, use, and share mental health practices employees can easily implement. 

Employer Q&A Session: 
The second half of the webinar was a question-and-answer session featuring guest experts Diana Clark, Benefits Manager at Promega Corporation, and Julie Norland, Human Resources, SPHR, SHRM-SCP at MRA. They fielded questions from employers in attendance regarding health benefits, communication strategies, and understanding the employee mindset. 

Diana also spoke about adding COVID-related benefits, promoting mindfulness and meditation, social-emotional intelligence training, shifting fitness initiatives to a virtual setting, creating a volunteer-based quarantine task force, and introducing Yammer for improved social connections across their 600-person company. She also outlined how Promega offers text messaging-based counseling to better support their younger employees’ mental health and to “meet them where they are.” 

Julie expressed how employers should remind their employees to use their benefits and offer reassurance that taking advantage of those benefits will not be held against them. (And when it comes to mental health specifically, employers should remind and reassure employees that their sessions are completely confidential.) She also suggested employers take the time to understand the distinction between remote workers and essential workers, and to make sure both groups feel valued – from safety assurances to boxed lunches and simple “thank you” messages.  

You can watch the full webinar recording – including the entire Q&A session – here. 

For more information on behavioral health providers in The Alliance network, please visit our Find a Doctor tool.





The Alliance and Business Health Care Group (BHCG) hosted a webinar with several content experts to discuss employee communication strategies, policy and procedures, and other employer considerations regarding COVID-19 vaccination. This is a recap of the virtual event. Click here to view the full recording. Click to skip to the Employer Resources section. 
How important is workforce vaccination for employers? 
The Wisconsin Department of Public Health kicked off the event by explaining a large fraction of population needs to be vaccinated to achieve herd immunity, and that employers play a critical role in vaccination communication. 

They produced an anonymous survey that had 4,451 employer-respondents answer questions about their roles in vaccination, the importance of vaccination, and barriers to vaccination. Below are some of those results:









According to these results, three out of every four employers surveyed believes that:  

They play some role in getting employees vaccinated. 
Workforce vaccination is at least moderately important. 
At least 60% of their workforce is willing to get vaccinated.

How can employers encourage vaccination among employees? 
Per the Wisconsin DHS, employers can help encourage vaccination using three methods: offering education, reducing barriers, and providing incentives. 

Educate: Utilize trusted messengers (health care providers, DHS/CDC, company management), address vaccine efficacy and safety concerns, use multiple communication channels (flyers, meetings, company intranet,) and account for differential reading levels and languages spoken. 
Reduce Barriers: Support paid leave to allow employees to get vaccinated, support paid leave for employees with side effects, host employer-sponsored vaccine clinics. 
Offer Incentives: Studies show that offering a financial incentive to get vaccinated can reduce unvaccinated workers by as much as 30%. 

The CDC has a great toolkit to help employers mitigate vaccine hesitancy within their workforces; it’s written in plain language and contains newsletters and posters that are available in multiple languages. 
Practical Vaccination Considerations for Employers 
As previously mentioned, educating employees about the safety and efficacy of vaccine side effects is important to break down misinformation; symptoms are usually minor and short-lived, quickly subsiding after two days. However, there are some practical concerns employers should consider. 

Fever, fatigue, chills, and muscle aches are possible, uncommon symptoms, and on occasion, may result in lost work time. Ideally, employees should stay home with a fever and only return to work once it has been resolved. 

It’s possible for an employee to contract COVID-19 the day they are scheduled to be vaccinated. If an employee reports symptoms such as cough, shortness of breath, sore throat, and loss of taste/smell, it’s very unlikely those symptoms would be caused by the vaccine. Employees with these symptoms should be tested for COVID-19 and follow the CDC’s guidelines for possible virus infection. 

It should be noted, per CDC guidelines, that quarantine after COVID-19 exposure is not required after an employee is fully vaccinated (both doses,) within 3 months of their last dose, and have no symptoms. Employers should still use physical barriers, masks, and other meaningful safety measures to keep all their workers healthy, as it will take quite some time for herd immunity to take effect, if at all. 

If employers take an active role in getting their workforce vaccinated, they may consider staggering their vaccination schedules to account for any absences due to side effects. (For example, they may vaccinate 1st shift on a Monday, and 2nd shift on Thursday.) Staggering is probably more important after the 2nd dose because more symptoms are usually more severe after the second dose.  

A challenge with staggering vaccination schedules comes down to the logistical administrative burden and using a two-dose series of vaccinations could delay your workforce’s overall vaccination rate. To reduce the possibility of lost-work time due to side effects, employers might consider scheduling their employee vaccinations on a Friday. 
Employer options for approaching vaccination in the workplace 
Lindsey Davis, Partner at Quarles and Brady, and a member of the firm’s Labor & Employment Practice Group, outlined three possible roadmaps employers can follow in regard to vaccination programs. 

Compulsory vaccination programs: This method requires the vaccine and best protects the workplace and community’s health. 

Positives: 

Reduces costs of absences, lost productivity, and long-run medical care.
Better allows employers to open and stay open.
Defends against civil liability
Protects against enforcement action 

Downsides: 

Significant administrative undertaking.  
Potential employer liability related to vaccine
Navigating distrust of the vaccine in the workplace
Need to develop an exemption process and consider accommodations
Disciplining and/or terminating employees for noncompliance 

Industries that might consider this option would have high levels of contact between employees and customers, frequent and close-proximity contact between employees, and businesses that depend on a high level of comfort for patronizing customers. Those industries could include: Healthcare, Dining and Hospitality, Customer-Serving Businesses, Educational Institutions and Daycares, and the Travel industry. 

Employers with a union presence or who have less “high-risk” work environments would not consider a compulsory vaccine program. 

Should an employer choose this vaccination program, they will also need to determine: 

How to track compliance and identify what proof of vaccination is required
Make a plan to process exemption requests (both medical and religious)
Strategize how to build employee buy-in (education, incentives, etc.) and plan for conflict diffusion.
Assess how to minimize (and if possible, eliminate) vaccination costs
Anticipate employee time-off requests due to the time necessary to receive the vaccine or adverse vaccination side effects
Consider any potential discriminatory impact of a narrowly tailored vaccination requirement. (For example, if vaccines are required only for employees who cannot work remotely)
Create and communicate a vaccination policy 

Employer-Encouraged vaccination programs: This method is often the most popular choice for employers. 

Positives:  

Administrative ease
Higher employee morale and retention rates
Less liability risk for discrimination claims 

Downsides:  

Lower compliance than a compulsory program
Widespread uncertainty and disinformation surrounding vaccines
Cost of incentives
Potential that incentives are deemed coercive and/or discriminatory. 

Employers who might consider would operate in workplaces that do not require close contact, or one that can accommodate remote work, but one in which that arrangement is winding down. 

Should an employer choose this vaccination program, they would also need to determine: 

How to track compliance and identify those who have received the vaccine
Take a thoughtful approach to continued PPE and distancing requirements
Consider incentives (paid time off, vaccination bonus, reimbursement for transit and childcare costs, etc.
Consider practical implications for employees who choose against vaccination (reminding employees they may be required to quarantine without paid time off, etc.) 
Create and communicate a vaccination policy 

Voluntary vaccination programs: This program does not encourage or incentivize vaccination and negates some legal risks, but brings about different ones. 

Positives: 

Avoids certain legal risks (but opens the door for other risks, noted below)
Low administrative costs
Less practical difficulties (obtaining proof of vaccination, forms, processes, etc.) 

Downsides:  

Other legal risks – potential for a case to be made the employer is not creating a safe work environment (OSHA, Tort, or Workers’ Compensation claims)
Harmful business implications by not creating safe space for customers
Diminished employee morale and retention from employees that want vaccine 

This strategy is more practical for remote workforces: Finance, Marketing, Consulting, Customer Service, etc. Employers who might not consider a voluntary vaccination program include: Healthcare, Education, Emergency Response, Public Transportation, and Food Retail Services. 

Should an employer choose this vaccination program, they would also need to distribute educational materials and create and communicate a vaccination policy. 
Best Practices for employers and the vaccines: 
There are a few options when it comes to vaccination policy for employers, and the best one depends upon an employer’s industry, the nature of their operations, and the overall size of their workplace. No matter what stance an employer takes on vaccination policy, here’s a summary of general rules they should follow when implementing a workplace strategy: 

Lead by example: having your C-suite get vaccinated before everyone else may be beneficial.
Educate and empower your employees using reliable information from trusted educational resources: CDC, WHO, FDA, and DHS
Be transparent with your workforce on policy and be prepared to answer questions
Have a plan and policy regarding COVID-19 vaccination, and depending on your size, consider creating a COVID-19 task force that meets on a regular basis
Maintain safety precautions (washing hands, wearing masks, and social distancing); mitigation strategies are still critical during vaccine rollout 





The Alliance awarded Matt Ohrt, VP of HR and Medical Services at Merrill Steel, with a Health Transformation Award on Oct. 1, 2020, in recognition of significantly improving his community’s access to high-value health care by creating an on-site and mobile health clinic. The Alliance created a case study capturing Matt’s journey so other employers can emulate his success. This article is a condensed version of the case study. 
PLANTING THE SEEDS OF CHANGE 
Matt first started down the path of creating a clinic after some internal discussions within Merrill Steel after seeing just how poorly Wisconsin compared to other states in terms of health costs. 

“We learned that Wisconsin is the second-highest state for health care costs, so it kind of becomes a necessary action when you see the disparity from, say Michigan, that's averaging about 150% of Medicare, while Wisconsin is averaging 400% of Medicare.” 

Matt was likely referring to RAND Corporation’s Hospital Price Transparency Study, which used claims data to compare hospital prices paid for by privately insured patients as a percentage of Medicare. 

Once he understood how damaging the cost of health care was to his community, Matt began working to improve the quality and accessibility for his nearly 500 employees by implementing a direct primary care clinic on-site.
DIGGING DEEP FOR FUTURE SAVINGS 
It would not be easy. They needed a state permit to recreate the space and received two commercial bids for the project – the cheaper of which came in at $370,000. 

“We thought, ‘Boy, we could build something for that,’ but we really wanted it to be on-site.” So Matt decided to take matters into his own hands – quite literally – and went to Merrill Steel’s ownership with an unusual proposal.  

“After the second commercial bid, I looked at one of the owners and said, ‘I have a background in general contracting. I can find subcontractors and manage this process for us.”

Matt did general contracting for seven years throughout his college career, and with ownership’s blessing, he used that experience to assemble his team and started building the on-site health clinic completely in-house. 
THE FRUITS OF LABOR 
When it was all said and done, Merrill Steel’s initial, up-front investment totaled a quarter of a million dollars – all before they saved a single cent.  

However, Matt quickly rewarded the ownership’s faith in him by providing a quick return on their investment. 

“We’re self-insured, and we’re spending over $5 million on health care, writing checks for stop-loss insurance, etcetera – so cost was a big factor for us,” Matt explained. “We were seeing 9% cost increases year after year, but since 2016 we’ve saved $4 million.” 
THE DOCTOR IS IN 
But Matt didn’t stop there. Once Merrill Steel started realizing big savings from the on-site clinic, they were able to focus on other areas they could save, too. 

A large portion of Merrill Steel’s health care costs were being spent on expensive imaging services like MRIs, ultrasounds, and X-rays, and considering how rough-and-tough the nature of steelwork can be, those stats are not unique – but how Matt solved it was.  

He bought and refurbished an old ambulance, transforming it into a mobile health clinic that makes house calls. 
DRIVING TOWARDS HIGH-VALUE HEALTH CARE 
Giving new meaning to direct primary care, the mobile health clinic provides special accessibility to health care services and saves Merrill Steel and its employees on health care costs by avoiding urgent care and emergency room services. It’s a convenient vehicle for prescription medications, injury treatment, and is even outfitted with a mobile X-ray machine. 

Merrill Steel offers some incredible services at their on-site clinic, too – IVs, lab work, casting services, suturing, MRIs, X-rays, and physical therapy – and all at equivocal or lower costs than what their local health systems charge. The clinic can also prescribe, saving employees time and money to fill prescriptions without the cost or hassle of additional office visits. 
GAINING EMPLOYEE “BUY-IN” 
However, having great access to a top-of-the-line on-site clinic doesn’t necessarily translate to better health care and more savings – employees need to use the resources they offer. 

“We have around 600 members with a 60-70% participation rate, so gaining more participation is still an opportunity for us,” explained Matt.  

Building trust and getting a hardworking, salt-of-the-earth type workforce takes time, educational resources, and constant communication. Merrill Steel made a deliberate decision to promote constant contact between their employees and their clinic provider, Astia Health.   

“Every year we have Astia Health come to our Christmas party and our Family Fun Day,” Matt explained. “But on a day-to-day basis, we encourage them to walk around the office and interact with and be one of us.” 
RELATIONSHIPS: THE CORE OF PRIMARY HEALTH CARE 
Those contact opportunities warm up employees to visiting the clinic, where the real relationship-building happens. 

“We wanted the clinic to be relationship-focused from the get-go so employees would feel comfortable, and they don't open up to that provider in a rushed, 15-minute appointment,” Matt explained, “but when you can spend 60 minutes talking with an NP, you begin to trust that person and can open up and ask for help.” 
NEXT STEPS FOR MERRILL STEEL 
Matt emphasized that not everything happened at once and that there’s always room for improvement. They started with a vision to build an on-site clinic, which they periodically upgraded, and it all eventually led them to create a mobile health clinic. So, what’s next? 

“We have some big goals ahead of us, including expanding the mobile health clinic's hours, benefit plan design and revising our wellness program to offer significant dollar contributions to employee HSAs. We’re going to do a lot more direct contracting and allow employees to shop for healthcare in a free-market atmosphere by guiding and incentivize employees and their families to go to providers that are – one, providing high- quality care, and two, that are transparent and competitive in their price.” 

Matt and his team plan to add chiropractic services to their top tier of The Alliance Premier Network. That means free adjustments for employees and their families while preventing expensive and painful surgeries. 
A LEADER OF HEALTH CARE INNOVATION FOR WISCONSIN 
Shortly after Matt received a Health Transformation Award from The Alliance, he accepted the Employer/Purchaser Excellence Award on his employer’s behalf from The National Alliance of Healthcare Purchaser Coalitions. Previous winners of the award include some big names like Walt Disney, Wal-Mart, and another employer of The Alliance – Brakebush Brothers, Inc. 

“I’m not motivated by awards,” said Matt. “We’re the second-to-highest cost state for health care in the nation, so there's good motivation for me to help people – but also to help our companies survive and prosper and be competitive in the marketplace.” 



The Alliance, Business Health Care Group (BHCG), and WEA Trust and Health Tradition Health Plan were pleased to host a webinar with the University of Wisconsin-Madison Population Health Institute on Dec. 10. The webinar featured Dr. Jon Meiman, Chief Medical Officer and State Epidemiologist for Environmental and Occupational Health at the Wisconsin Department of Health Services, and Dr. Robert Meyer, Occupational Medicine Physician for Bellin Health Systems. This is a recap of the virtual event. Click here to view the full recording. Skip to employer resources section. 
Current State of the Pandemic 
Dr. Meiman briefly covered Wisconsin’s pandemic status and its strain on our health care system. Hospitals have seen exponentially more cases in the past three months, and when hospitals are full, it impacts the care of all patients. The number of patients hospitalized peaked in Wisconsin, reaching 2,278 on Nov. 16. Another factor Dr. Meiman said we could not overlook is the economic impact the pandemic has caused. Merely looking at unemployment, there’s been a massive spike – which has significantly improved – but there are people and businesses still struggling. 
COVID-19 Transmission 
Dr Meiman moved to the scientific evidence of how COVID-19 spreads and quickly ran through what we know about the virus thus far. 

- It can be contracted from contaminated surfaces. 

- After exposure, it can take up to two weeks to develop symptoms. 

- Roughly 20% of those infected never develop symptoms but can still spread the virus. 

- Spread happens through droplets (from the mouth), covering short distances (less than 6 feet). 

However, Dr. Meiman expressed that avoiding close contact – being more than 6-feet apart for less than 15 minutes at a time – may be an oversimplification when considering one’s risk for infection. There’s strong evidence supporting that high-density occupancy, poorly ventilated indoor facilities, and activities like singing or shouting can spread more droplets further. Therefore, avoiding close contact, by definition, is likely insufficient in circumstances where any one of those three elements occur, and extreme caution is encouraged. 
Drivers of Transmission: 
Dr. Meiman then discussed the three drivers of virus transmission: Within households​, in common gathering places, and within workplaces. 

He explained that in a recent CDC study conducted in Tennessee and Marshfield, Wisconsin, after a family member of a household tested positive, 53% of all other household members ultimately tested positive. To further illustrate his point, Dr. Meiman showcased a study in Singapore where poor migrant laborers living in dormitories or barracks made up 88% of Singapore’s total cases nationally. 

As far as common gathering places and workplaces go, Dr. Meiman pointed out that congregation and close contact poses a risk anywhere, and workplaces can create an environment for the rapid spread of COVID-19 among employees without proper procedures and safeguards in place.  
Managing Risk for Employers 
Next, Dr. Meyer shifted to talking about what employers can do to manage COVID-19 in the workplace. 

He displayed a diagram of The Swiss Cheese Respiratory Virus Pandemic Defense model that employers can deploy to stop a virus. The model recognizes that no single intervention is perfect at preventing the spread of a virus, and although each intervention (each slice of swiss cheese) has imperfections (holes), by using multiple layers of defense, we can improve our chances of successfully defending the spread of the virus. 



The personal interventions that are proven to help prevent the spread of disease are: 

Physical distancing
Staying home when ill
Hand hygiene and cough etiquette
Avoid/Limit time spent in crowded spaces

The shared interventions proven to help prevent the spread of disease are: 

Swift and sensitive testing and tracing
Proper ventilation
Government messaging and financial support
Quarantine and isolation
Vaccines 

Dr. Meyer ended the model’s discussion by explaining that when individuals, employers, and public health work together, we can use all the intervention tactics in synergy to defeat the virus’ spread. 
Providing Critical Employee Education 
He then explained that to educate employees, employers should consider a few elements. First, to make sure messaging and educational resources are clear and concise. Employers should also have a firm grasp of the ethnicities of their workforces and ensure communication pieces are made readily available in languages other than English, if necessary. Dr. Meyer then went over a simple checklist for employers to convey to employees consistently: 

Stay home when sick
Wear a mask at all times (when possible) 
Wash your hands often 
Keep your distance and avoid the “three C’s” 

Avoid crowded places 
Avoid close-contact settings 
Avoid confined and enclosed spaces 




Creating a Safer Work Environment 
Dr. Meyer admitted that some businesses might have more trouble than others creating safe spaces, but he believes there’s always something employers can improve on. He outlines four key areas of for employers to pay attention to: 

1) Environmental Modifications: Employers can audit their workflows. They can then decide to deploy changes by manipulating their employees’ physical environments to prevent spreading. For example, they can change the distance that separates employees (physical distancing,) install physical barriers (when physical distancing isn’t possible,) upgrade their workplace ventilation systems, and improve their symptom screening system. 

2) Universal Masking Requirements: Require employees to wear masks at all times (when feasible). 

3) Employee Training and Education: Employers should provide their employees with proper hygiene and protective behavior training in multiple ways as often as possible. They should also equip their employees with appropriate PPE to empower them to do their jobs safely. Employers should have policies and procedures in place, make sure employees know them, and revise as new information comes to light. Further, Dr. Meyer re-emphasized the need for all communication pieces to be written in clear, concise language and in all appropriate languages for their specific workspace. 

4) Workplace Policies That Reduce “Presenteeism”: Lastly, Dr. Meyer suggested implementing policies that reduce the occupational transmission risk that employees pose by working while symptomatic. Flexible work policies, like remote work (when possible) is ideal. Providing employees with paid sick leave is also advised, and employers are encouraged to review their “perfect attendance” policies and temporarily suspend or amend incentives for good attendance. 
Working With Your Local or Tribal Health Department 
Finally, should an employer have someone test positive, they should work with their local or tribal health department (LTHD) to keep their business open. Two or more workers with COVID-19 in 28 days constitute an outbreak investigation, and employers should contact the LTHD as soon as possible to operate the investigation.  

Dr. Meyer made clear that “whether or not the outbreak is workplace-related does not change how you work with the LTHD to stop COVID-19 in your workplace. Outbreak investigations are faster and more effective when started quickly. Confidential information will be exchanged and protected as you work with the LTHD to stop the spread.”  

Prompt action is necessary for large businesses, and quickly identifying close contacts prevents a small outbreak from spreading uncontrollably. 

How Does an Employer Conduct Testing? 

Testing in the workplace can be done by a health care provider or community testing site. Testing is critical when trying to manage an outbreak that is rapidly growing. As a quick rule-of-thumb:​ 

PCR tests are highly accurate, expensive, and the turnaround time can be long​ 
Antigen testing is cheaper, faster, but also less accurate​ 

For outbreaks: LTHDs will determine the best testing strategy based on the information they have. 

For routine testing of employees: work closely with occupational health providers. 
Vaccines – When, Where, and How Many? 
Pfizer’s vaccine is expected to be authorized soon, while Moderna’s is currently under review. Both vaccines are highly promising, offering over 90% efficacy, and both require two doses. 

However, Wisconsin’s initial allotment of vaccines is just under 50,000 doses (or just under 25,000 people), and the CDC vaccine advisory committee (ACIP) is recommending the following groups as priorities for vaccination through three phases: 

Phase 1a: Health care personnel and long-term care facility residents. 

Phase 1b: Essential workers 

Phase 1c: Adults aged 65+ and adults with high-risk medical conditions. 

Dr. Meyer said that regardless of vaccine prioritization, the supply will be extremely limited and its rollout will be logistically complex. In other words, it will take months. So how can employers help? Dr. Meyer suggests promoting vaccination now to help increase public trust in the vaccine, and when the time comes, employers can help facilitate getting vaccines to their workforces. 
We Can Stop the Spread Together 
Dr. Meyer closed his portion of the webinar with a call for prudence. “More Americans are infected now than ever before, so over the next several months we still need to test, trace, isolate, quarantine, wear masks, and socially distance.”

The webinar concluded with specific employer questions that were answered in the webinar. You can view its recording here. 



The Alliance hosted their 30th Fall Symposium & Annual Meeting on Thursday, Oct. 1 as on online event. This article recaps the keynote speakers in the latter half of the event, but you can re-watch the event in its entirety here. 
Employers Are The Key To Unlocking Better Prices 
The Alliance invited Chris Whaley, Policy Researcher at RAND Corporation, to discuss the recently released results of their Hospital Price Transparency Study. The study examines the costs that employers pay for hospital prices, benchmarked against Medicare across the United States. 

Chris started off his presentation by displaying the sheer magnitude of employer-sponsored health coverage. “Employers cover half of Americans – or 160 million people – with $1.2 trillion in total health care costs in 2018, and $480 billion of that was hospital costs.” 

Then he reviewed what we already know about health care: the prices paid by employers are rising much more rapidly than Medicare and Medicaid, and employees are paying more for health care every year, while wages have remained relatively the same. 

“These rising health care costs place a tremendous amount of pressure on employers and their populations. This is especially true during the COVID-19 pandemic,” Chris said. In fact, it’s likely that Americans will spend one out of every five dollars on health care in 2021. 
Key Takeaways from RAND Corp Study 
After level-setting, he delved into the data by showing that commercial prices relative to Medicare have increased from 224% in 2016 to 247% in 2018. In other words, employers are paying 2.5 times more for the same inpatient and outpatient services at hospitals than Medicare – and that disparity continues to grow at a compounded interest rate 5.1% annually. 

Next, he showed that, relative to Medicare, commercial prices, facility prices, and professional prices all vary widely across states, within states, and within hospital systems in those states. For example, Wisconsin ranks 3rd highest in professional prices and pays nearly 350% more in that category, while Illinois pays just under 200% more for those same professional services. 

More importantly, he showed that there was no correlation between the differences in hospital pricing and “low” government reimbursement for Medicare – what health systems refer to as “uncompensated care” – to account for the variation of prices. 

In terms of quality, Chris explained that while there are many high-value hospitals across the country, there’s no real evidence to suggest that safety and quality are commensurate with price. “All the outcomes that health care purchasers value, such as patient convenience and hospital reputation do not show a clear link between hospital price and quality/safety.” 
How Employers Can Use RAND Corp Study 
“The wide variation in prices for hospital care presents a really important savings opportunity for employers. Employers can use innovations and benefit plan design strategies to save money and get more value for what they’re paying. But employers need to do a better job in demanding transparent information on prices.” Chris went on to say that when employers have transparent information about prices, they can benchmark those prices and demand change from hospital networks.  

Chris admitted employers could use some help from state and federal policymakers in that arena: “70% of hospitals are in non-competitive, dominated markets, so if there’s only one or two hospitals in your market it can be tough to demand fairer prices as a smaller employer.” 

Despite those obstacles, Chris outlined a few pieces of regulatory reforms employers can push for to improve prices in the future: 

An all-payer claims database that highlights the variation in prices. 
Policies that promote competition and eliminate gag clauses.
Limits on out-of-network charges and surprise billing. 
All-payer or global budget programs (also known as Total Cost-of-Care Contracting). 
Enroll in RAND 4.0.

Driving High-Value Health Care at The Alliance 
The next portion of the Symposium was a presentation by leadership at The Alliance, Melina Kambitsi, Ph.D., and Kyle Monroe, who used the four core drivers of high-value health care to explain how employers who work with The Alliance can work on combating the high prices the RAND study illustrated. 

Kyle began by stating simply, “The Alliance believes health care prices should be simple, predictable, and transparent; simple for purchasers and consumers to understand and easy to compare rates from different provider organizations, predictable for costs for services, and transparent with accessible cost and quality information for purchasers.” 
Reference-Based Contracting by The Alliance 
He went on to say that some organizations are already trying to discredit the RAND study, “They say this is impossible: that benchmarking to Medicare is inappropriate, or Medicare’s methodology is flawed, or that providers will never agree to something like this. Let me be very clear, anyone who says it isn’t possible or that it can’t be done is flat out wrong.” 

Why? The Alliance is already doing it with Reference-Based Contracting; more than 80% of our contracts are repriced using referenced-based contracts benchmarked to Medicare. “Using a percentage of Medicare resets the starting point for pricing from billed charge to something with a rational base rate, plus discounts and adjustments.” 
Total Cost-of-Care Contracting
Kyle then explained that Reference-Based Contracting – what we’re doing now – leads us to Total Cost-of-Care Contracting – what we’re moving towards. “Medicare-based agreements are a good start, but they are not the end goal. Total-Cost Contracting, also known as global payments, transfers [more of] the financial risk to the providers.”

This method could provide subscription-based fixed payments for patients and force providers to allocate a budget for services, so if they go over budget, that money would come out of the provider’s pocket, not the employer’s. It would also provide robust and transparent data and analytics, more intimate relationships with provider organizations, and incorporate actionable quality data. 
The Growth of Smarter Networks℠ 
Kyle shifted the focus of his presentation to Smarter Networks by The Alliance. “Our membership is growing so our network has to grow, and we don’t just grow the network for growth’s sake, we only add providers that add value for our members.” 



The Alliance designed Smarter Networks as a platform to align incentives for all stakeholders and provide innovative plan design. Employees want options to go to high-quality providers and pay as little as they can, employees and plan sponsors want the best outcomes for the lowest price, and providers want to work with employers. Our networks promote those high-value providers.
The Alliance Premier Network 
He then displayed how the latest offering by The Alliance, The Premier Network, is unique in that it reduces costs, removes barriers to care, and promotes high-quality care. “We were able to negotiate rates for providers in the Premier Network that were 15-30% lower than The Alliance Comprehensive Network.” 

The Premier Network is a customizable multi-level benefit plan for employers that incentivizes patients to choose high-value providers without limiting their choice. 

Melina joined the discussion to explain how tiering in the Premier Network may work using a current member’s network design: 

Tier 1 – Non-emergent schedulable procedures and on-site clinic with preferred providers. 

Tier 2 – Specialty care and emergency care with secondary preferred providers. 

Tier 3 – Wrap Network with other health systems. 

Tier 4 – Out-of-Network reference-based pricing with AMPS (another new offering to negotiate with those providers that may be outside The Comprehensive Network by The Alliance)
Achieving Advanced Primary Care 
In addition to all the expanding network and new product offerings, Melina talked about the importance of Advanced Primary Care for employers. “We know that care starts at the primary care physician’s office. We also know that over 80% of patients with chronic physicians see their primary care doctor multiple times per year. And because primary care is the least expensive care, the PCP visit has become the most important type of care.”

However, Melina explained that misaligned incentives, lack of behavioral health integration, and lack of appropriate referrals at the primary care level drive up costs, compromise the effectiveness of care, and reduce patient satisfaction. She then went on to explain the characteristics of Advanced Primary Care and how it combats those issues: 
Enhanced Access for Patients  
More physician-patient time, enhanced scope of services, more immediate care availability, and availability outside of clinic operation hours  
Evidence-Based Medicine  
Care teams avoid test orders not linked to evidence and change management. Standing orders and protocols for patients with chronic disease management.  
Risk-Stratified Care Management  
Each patient receives care based on their unique needs: extended office visits, care manager guidance, monitoring, and tracking, phone check-ups, etc.  
Care Coordination  
Primary care team that engages in outreach, including chronic care condition management; coordination of care; and ensuring patient understanding of medications, orders, adherence expectations, etc.  
Care Navigation  
Careful selection of specialists – clinicians use a narrow list whom they trust and remain in constant contact as treatment plans develop.  
Organizational Infrastructure & Backbone  
Analytical and reporting capabilities, EMRs, coordination and communication with other providers, payers, and continuous staff improvement and training.  
Behavioral Health Integration  
Using patient records, care teams can identify patients who may need outreach to assess behavioral health needs through multiple methods of connection.  
Balanced Compensation  
Rewarding care management team based on quality of care – care quality, patient experience, resource use and referrals – not volume of care. This global payment methodology differs from traditional primary care, which uses fee-for-service payments and third-party payers.  
Referral Management  
Fewer referrals outside of the primary care ecosystem. 
2020 Health Transformation Awards
The Alliance ended the event with their 30th anniversary video and the announcement of the 2020 Health Transformation Award Winners. The Alliance will be providing additional, in-depth articles outlining the success of each HTA winner in the coming months. The intent is to share employer-specific strategies in achieving high-value health care and to promote them to our membership so other employers will gain an opportunity to emulate their successes. Here were this year’s winners:  

WHIO (Wisconsin Health Information Organization) 
Traci Rothenburger, Clinic Manager at Nordic PrivateCare 
Matt Ohrt, Director of Benefits/HR at Merrill Steel 
Tena Hoag, CFO at Advanced Laser 

To watch the event in its entirety, please click here. 



In our third and final Direct Primary Care webinar installment, our own Melina Kambitsi, PhD., hosted Proactive MD’s executive vice president of direct care services, Justin Leigh, to discuss what makes Direct Primary Care so impactful.

During the second portion of the webinar, The Alliance brought back three employer-members from our previous webinar to answer more questions from their fellow members. A big thanks to Dan Ludwig of Brakebush Brothers, Tena Hoag of Advanced Laser, and Jake Nolin of Rice Lake Weighing Systems, for rejoining us.

You can view the webinar in full here. 
What is Advanced Primary Care?
Melina started the webinar by explaining that, as the voice of self-funded employers, The Alliance remains focused on providing High-Value Health Care to its members using our four core drivers: Transparency, Payment Reform, Benefit Plan Design, and Provider Network Design. High-Value Health Care happens when individuals have access to higher-quality care that costs less, and The Alliance believes the best way to achieve it is by implementing cost and quality strategies at the source – the primary care level.

In fact, as Melina explained, “Over 80% of patients with chronic conditions access primary care, making it the most prevalent type of office visit. It is also the most affordable type of service [for the patient] and least expensive [for the employer]. 

However, within our current health care system, traditional primary care has missed the mark due to, in Melina’s words, “Misaligned payment incentives, lack of behavioral health integration, and lack of appropriate referrals – to potentially inappropriate testing, but also to specialists who drive up costs – and compromise both the effectiveness of care and patient satisfaction.” 

Enter Advanced Primary Care, an elevated standard of primary care that’s measured by improved health outcomes for patients, lowered total health spend for employers and employees, and achievement towards higher levels of patient satisfaction and activation. 

Through our research over the past year-and-a-half, speaking with brokers, consultants , our employers, and the National Alliance of Healthcare Purchaser Coalitions – the broad umbrella organization of all coalitions in the country We have identified the key characteristics of Advanced Primary Care.” Those nine characteristics are outlined below:

Enhanced Access for Patients  

More physician-patient time and an enhanced scope of services, more immediate care availability, and availability outside of clinic operation hours. 

Evidence-Based Medicine  

Care teams avoid test orders not linked to evidence and change management; standing orders and protocols for patients with chronic disease management.  

Risk-Stratified Care Management  

Each patient receives care based on their unique needs; extended office visits, care manager guidance, monitoring and tracking, phone check-ups, etc. 

Care Coordination  

Advanced primary care teams engage in outreach, including chronic care condition management, coordination of care, and ensuring patient understanding of medications, orders, adherence expectations, etc. 

 Care Navigation  

Careful selection of specialists – clinicians use a narrow list whom they trust and remain in constant contact as treatment plans develop.  

Organizational Infrastructure & Backbone  

Provides analytical and reporting capabilities, complete Electronic Medical Records (EMR’s), coordination and communication with other providers, payers, and continuous staff improvement and training.  

Behavioral Health Integration  

Using patient records, care teams can identify patients who may need outreach to assess behavioral health needs through multiple methods of connection, supporting patients through ongoing treatments. 

Realigned Payment Methods 

Rewarding care management team based on quality of care – care quality, patient experience, resource use and referrals – instead of volume of care (fee-for-service).  

Referral Management  

Advanced primary care produces fewer referrals outside of the clinic (less than 10%).  

Why Direct Primary Care?
Because, according to Melina, “Direct primary care improves patient health and lowers the total cost of health care. Our expectation is that the total cost of healthcare will be lowered by about 15%.” 

And how does this innovative primary care model work? It is patient-centered care for the whole family and is a membership-based model, so there’s no insurance required and pricing is transparent. Instead of aiming to generate the more specialty care, our direct primary care system exists to generate more health.

In other words, direct primary care emphasizes developing and maintaining a trusting patient-physician relationship while utilizing an alternative payment method that greatly improves access to high-quality care with a flat, affordable membership fee. 
Proactive MD Partnership & The Patient Promise
Melina then turned it over to Justin Leigh to talk about Proactive MD, a primary care organization that’s been in the value-based primary care business for about 10 years and operates 60 locations. 

 “Our core philosophy is centered around our patient promise and using a direct primary care approach,” Justin continued. “Our physicians are seeing no more than 10-12 patients per day, and a lot of the issues with health care – primary care specifically – can be tied to volume. So by simply solving for the volume issue, and giving physicians more time with their patients, they can do a lot more for them.” 
True Patient Advocacy & Accurate Navigation
However, Justin said that it’s not just about time spent with patients, but the ease of access that’s important for patients, too. “We can deliver same-day appointments over 99% of the time and our average wait time is below five minutes.” This increase in access, availability, and physician-patient time, when combined with the elimination of co-pays, creates a high-value model with high levels of patient satisfaction. 

He explained the importance of high patient satisfaction for employers when it comes to benefit plan design. “By offering employees unlimited access to high-quality care without the traditional hassles, it becomes a great enhancement to their employee benefit offering.” 
Experienced Data Analysis for Better ROI
Proactive MD’s direct primary care solution is all about data – which The Alliance knows and understands well – so both organizations are a good fit for one another. “On the back end, we’ve been servicing larger self-funded clients for about a decade now, so we have a fantastic data science team that works in collaboration with The Alliance to do all our claims analysis and reporting,” Justin said. “By risk stratifying across the entire population, we can start to engage in true population health measures; we can do targeted outreach, condition-specific outreach, and we can customize what that outreach effort might look like.” 



“Clients who are interested in a direct primary care clinic model want to see a return on investment. They love the idea of enhancing their employee benefits, but they need to see savings. That’s why we stand behind strong performance guarantees and have designed pricing models that eliminate a lot of the risk associated with a clinical strategy – but the ability to release as little as possible into specialty care is what truly drives savings.” 
The Total Health Solution
Melina rejoined the conversation to state how The Alliance has developed a solution that can work for all employers.

“Our offering doesn’t have an Alliance box around it; we are open to all employers – self-funded, all–insured, and even individuals – that want to participate. Of course, the employer pays a per–member per–month fee instead of a bill for each service. We provide clinic usage reporting to the employers and also the brokers, and more importantly, help the care team to identify the high-value providers with as close to a real-time data integration as possible.”





Lately, many of our self-funding members have expressed interest in starting an on-site clinic or joining a shared-site clinic that delivers Direct Primary Care. After all, Direct Primary Care has become an increasingly hot topic during the pandemic due to its monthly, per-patient payment method that lowers overall costs, and the emphasis it places on increased primary care access – like same-day appointments and telehealth services. 

The increased attention towards Direct Primary Care clinics has also grown since The Alliance announced the opening of our own Sun Prairie clinic in fall 2020. Given this, we want to provide our members with information to address any questions they may have, and who better to answer them than fellow employers of The Alliance cooperative? Dan Ludwig of Brakebush Brothers, Inc., Tena Hoag of Advanced Laser, and Jake Nolin of Rice Lake Weighing Systems, all graciously accepted our invitation to share their successes in establishing or joining clinics of their own.  
Employer Q&A 
“Why did you start an on-site clinic?” 
Jake Nolin: We had an ongoing health center strategy we’d been discussing for years, but what ultimately pushed us was facing down a 30% renewal increase – the equivalent of an additional $2 million per year – five years ago. We’re now 3.5 years into our clinic, and our health center is the focal point of our health strategy – it links everything together from being self-insured to benefit plan design, to steerage all the way down to contracted care, which we receive through The Alliance.

Tena Hoag: We felt like we were being taken advantage of and we knew we could provide primary care for less by opening our own clinic.

Dan Ludwig: We were also, year after year, facing double-digit premium increases while fully insured, so in 2014 we took control of it as part of a self-funded platform. Prior to 2017, we provided a musculoskeletal injury prevention program and that had great success. We thought, “if we can have success providing on-site services for soft-tissue injuries we can probably have additional success looking at primary care.” So we expanded our services to provide those on-site in 2016.

How did you get past any internal hurdles of moving to a self-funded clinic?
Dan: The biggest internal hurdle is obviously assuming the cost, but with the substantial increases we’d experienced and the new ones we were facing, our leadership was ripe for change. They recognized we couldn’t continue to do things the way we were. The cost of the clinic compared to the expected return made the ‘sell’ a lot easier.

Tena: Our ownership wanted to take care of the employees, and some felt that going down the on-site clinic path was “getting up in people’s business” and that’s certainly not who we were. So there was some difficulty selling that internally, but we knew the cultural shift would be a multi-year buy-in.

Jake: Our internal hurdle at the time was our President. We’re privately held and have a passion for taking care of our employees. He wanted something approximating old-fashioned health care where your provider knew you and spent more than 10 minutes with you. Getting a commitment for five or more years is a big commitment – it’s a big investment of money and time to put a clinic together. You need to be committed. If your CEO is a one-and-done type and won’t follow through after a bad year, and pulls the plug at the one-year mark, don’t even bother. It has to be seen as a long-term investment.
“How did you choose your provider/partner?”
Jake: That’s been a journey for us. We interviewed a number of different 3rd party providers and started with CareHere. They had 300 clinics around the country. We assumed that bigger was better. As it turned out, that didn’t work well for us because we wanted to do things like childhood immunizations and other things weren’t under their boilerplate. Last year we went to NeoPath Health out of Minneapolis, and they’re much smaller regionally as a 3rd party clinic provider. They have 10 sites in Minnesota. They understand us and listen to us when we say “we want to do this in our health center” and they want to make it happen. It’s been like a night-and-day difference.

Dan: Our original partner was handed the business because we had a long-term relationship with them from our wellness program. After about a year we discovered they had somewhat of a boilerplate of “this is what we offer in a clinic” and we wanted to be able to offer other things to our employees. I would encourage anyone going into a clinic is asking what they offer when developing your RFP, and ask if they’re comfortable with offering a particular service in your clinic. We selected ProactiveMD on March 1st, which is an interesting timeline because COVID-19 hit right as they were taking over. There’s been a very steep learning curve and we’ve gotten to know each other very quickly due to the pandemic. Overall, it’s been very positive.

Tena: 2-3 years ago, when we started down this path – we’re a small employer – we had about 100 employees and 65 of them were on our health plan. We didn’t have all the same options as our larger local businesses, so we interviewed some independent operations, but with our size and with our limited budget, we ultimately ended up in a shared-site clinic situation. In total, three local businesses that opened our clinic together. It’s a very different model, but that underscores the fact that you do have power – regardless of your size – you just need to find like-minded people to help take advantage.

“Are you being billed as fee-for-service or one monthly fee that includes all monthly visits, or PEPM (Per employee, per month) payment methods?”

Dan: Ours is a set monthly fee that covers the vast majority of services. Things that would be additional are higher-cost labs and some prescription drugs – everything else is 100% covered. All employees, regardless of whether or not they take our coverage, and all covered spouses and dependents can use our clinic. Our goal is to have everything free at the clinic. We do have about 10% of employees who choose an HDHP and the IRS gets their say to decide what we’re allowed to give for free, but we keep those costs as low as humanly possible.

Tena: Our shared-site situation is a bit different. The group shares a certain number of hours per week for the various services the clinic offers. We are often charged for our share of hours whether we actually use them or not. Excess capacity hours are split by a prearranged percentage that our group originally agreed upon.

Jake: Our clinic is private to our employees and family members on our “Take Control of Your Health” plan. There’s zero charge for anything at our health center. From prescriptions to procedures to wellness visits and referrals, nothing has a cost and it’s all pass-through, which means we pay an administrative fee and all costs are transparent and passed through to us. They pay them, and we reimburse them. We pay for everything down to the internet and salaries of six full-time employees.
How did you onboard different vendors?
Jake: It’s kind of like onboarding a new staff member. It’s really important for them to understand your goals; they have to understand the benefits. For all of our providers, they have all come from large health care systems so they understand how those systems work and how our systems are different, so we just had to explain our system and what we wanted to achieve. We had to ask them how they refer. And it’s important for them to understand our tiered plan design, so if they refer someone to tier one that person pays nothing, but if they refer to tier two or three, they are economically impacting our plan and our members. It took a lot of education, they don’t just pick up the plan design, and all the partners and lingo on the first go-round, but I remind them about it every quarter and align with them on a regular basis, and they’ve become subject matter experts.

We also use a Care Navigation Firm called Alithius in conjunction with The Alliance’s data, who is also well connected with our on-site clinic. All of our referrals go through Alithius and they provide different options for Tiers 1-3, both 1 and 2 are both provided through The Alliance and tier 3 is our old PPO plan, so Alithius is helping us with consumer education, and telling employees their options and they will direct them to a good decision whether it’s location or provider system that matters to them, they can have the information that they need to make a good decision. Well over 95% of our members are choosing Tiers 1-2 but Tier 3 accounts for 65% of our spend. 

Tena: Ultimately, we did not end up going with an independent operation, we are actually with a health system. It has worked out well for us so far. They’ve been very receptive to the vast majority of everything we’ve brought to them. We’ve found out to just ask. Just ask. Ask them how they can help us help our employees. There were a fair amount of bumps and bruises in the beginning but that has pretty well settled out. There are a lot more details that folks maybe don’t realize matter. It’s quite a process, it’s a journey, and I don’t think we’ll never be done making tweaks and improvements, but the important thing is to find someone who has flexibility and a willingness to be in it for the right reasons.
Tena, you have a shared-site clinic, so how did you all get together to create the clinic?
Tena: We had some local people to help make us smarter faster, we’ll call them circles of influence, and if your inquisitive and innovative connections start happening from there. That’s how I was introduced to a lot of different providers. This may sound simple, but we’ve found that the other businesses, by simply being involved in our community and attending chamber events or attending speaker meetings, you meet others who care about the same things that you care about. Then it grows from there. We connected with Spectrum industries and found out we were researching the same things at the same time, and we started a friendly relationship. Then when we were ultimately vetting out providers, another business in our area, Great Northern, was looking to add to their Chippewa Falls location as well. I’m very pleased with the businesses we’ve been able to partner with so far.
What services do you offer at your clinic?
Jake: Our clinic is actually a near-site clinic, and It’s about a mile from our facility. We bought a dental office that was available and retrofitted it into a 3200 square-foot clinic. We wanted everyone to have access to it, and it was also a timing thing – we didn’t have a lot of available space on our campus and we wanted to do it the right way. We didn’t want to shove people in a closet or a trailer, and in hindsight it’s worked out tremendously well; it gives people a sense of privacy when they get help and it keeps family from visiting employees while they’re at work. I like it and we think it’s worth a few minutes of inconvenience.

As far as our services go, we do primary care, acute care (stitches and getting particulates out of the eye), and chronic disease is a very big thing. When we went through the COVID-19 lull we went from 85% to 35% utilization. We used that time to do a lot of telephonic contact with people who have chronic diseases because wellness is huge for us. Even if an employee has just one appointment a year and it’s a physical, we reward them for it. We have a 125-drug formulary dispensary in our clinic, so lots of prescriptions can be picked up at no cost. We’re fortunate to have an NP and an MD who will both do in-office procedures. They’ll do injections, remove skin tags, things that would cost thousands at Marshfield or Mayo, and obviously they do referrals for medical and mental health. We do pre-employment drug screens and physicals, but we do not do Op-med. or workers comp. That’s separate.  

Tena: We have a PA who does all our normal primary care things. We also offer physical therapy which has become one of the most popular facets of the entire program. He does work both at the clinic as well as on-site. We just wove behavioral health into the contract in 2020, so now it’s really a one-stop shop for any physical or mental needs. 

Dan: Medically we offer primary care, urgent care, chronic disease management, labs, an on-site dispensary, and a robust muscular-skeletal program; they’re out in the plant looking at things from an ergonomic standpoint and doing employee surveys, looking for problem areas, and seeing if it’s an environmental issue or individual anomaly and trying to catch it early on before it progresses into something more severe. Of course, they do other things like physical therapy and rehab when we have an actual injury. We also bring an on-site orthopedic surgeon once a month who can do pre- and post-op consultations and injections. We just started with mental health at the beginning of the year, and it took off more so than we expected. It didn’t take long before people were utilizing that. We have a chaplaincy program here as well. We have on-site mammograms which is a mobile service, and we have at-home sleep study devices we can send people home with as well. We have a wide range of services we can keep in-house and last year we started doing on-site imaging with x-rays and ultrasounds with a mobile van who responds quite quickly to urgent care situations – oftentimes in an hour. And when you consider the alternative to driving 20 minutes to the nearest ER and waiting in the waiting room, sometimes it’s actually faster. 
How is your clinic connected to local providers?
Dan: We tell people if they have an existing relationship, that they don’t need to drop their doctor to use ours. They can use us within whatever fashion you’re comfortable with. If they only want to use us for urgent care? That’s fine. It comes down to individual choice. You have some people that use us as their medical home and some people that have been with their doctor for X number of years and really like them.

Jake: Almost everybody has migrated to our health center because we have a female DMP and a male MD. In relationship to the community, we have an imaging partner and PT partner that The Alliance assumed the contracts for, and that’s remained very strong. They do direct referrals. We are in a community within Marshfield and Mayo territory, and in the beginning they were very difficult in getting files transferred and recognizing us as a legitimate medical provider, but we’ve seemingly worked through that.
Through this experience what do you think your savings have been to overall health care spend?
Jake: I would say over 3.5 years we’re approaching 10 million dollars in savings. We have not had an employee contribution increase in five years. All our savings include the costs of the clinic. I would estimate that every dollar we spend on the clinic we get two back, which is pretty substantial. 

Tena: I can’t give you a long-term estimate in what we’re catching and preventing from happening. But I can say our savings are roughly $5,000 a month in terms of what our care is at the clinic vs. what it would be somewhere else. And keep in mind our total spend is less than a million dollars. The thing that makes me happiest about that, is that’s $60,000 that’s not coming out of the pocketbooks of our employees and that makes us feel good.

Dan: That’s been one of our struggles figuring out what exactly what is our total savings? Some of it’s easy, but the unnecessary fee-for-service referrals that we no longer have has been difficult to capture in terms of calculating savings. We’re preventing things. We have some conservative estimates, but one thing that’s very clear is we’ve experienced a savings every year since opening a clinic – even including the costs to run it. It’s about a 2-to-1 ratio in clinic costs which is substantial. 








The Alliance hosted Dr. Kayur Patel of Proactive M.D. and Dr. David Usher, M.D., of ReforMedicine, for our first of a three-part series on Direct Primary Care June 8.   

Missed the webinar? You can view it here.  
What is Direct Primary Care?  
Direct Primary Care is an innovative primary care model that emphasizes developing and maintaining a trusting patient-physician relationship while utilizing an alternative payment method that greatly improves access to high-quality care with a flat, affordable membership fee. It significantly differs from traditional primary care, which uses fee-for-service payments and third-party payers. 

Employers are growing to identify the benefits of Direct Primary Care for their plan participants and their healthcare expenditure, and are adopting this model by utilizing an on-site, near-site, or shared-site clinic. In fact, in response to the ever-increasing demand for this model of care, The Alliance is launching a Direct Primary Care clinic for employers. Under this model, employers will only pay for the plan participants who access the health center. 
Increased Time and Trust for Better Health 
Direct Primary Care places an emphasis on length and frequency of contact between patient and primary doctor. “There is no substitute for time spent with patients – building trust takes time,” said Dr. Usher. By increasing the time patients spend with their primary physicians, a trusting relationship develops, which enables a more fluid and seamless flow of information between the patient and provider. 

Practicing under this model, the physician inherently understands the patient and can make smarter recommendations and referrals. As Dr. Patel explained, “If the physician and patient spend more time together, they will intuitively make better choices for the patient and provide more complete care.”  
Primary Care Directs Total Health 
In today’s complicated health care world there’s a significant amount of specialty care and referrals, and there needs to be someone directing and managing each part of that care. Dr. Patel explained that direct primary care acts as that link and likened the primary care doctor to the quarterback of a football team.   

“The quarterback has to be the family [doctor] who has the ability to navigate all the various specialty care, and soon as the patient is seen by the specialist, the primary care doctor needs to reprocess that information and figure out what the next move is going to be,” he said. In other words, the primary care doctor is the key to total health for a patient.  
More Preventative Care = Less Emergency Care 
More importantly, because the physician is more in-sync with their patient, they’re now better able to direct focus on preventative care, which can negate the need for expensive ER and urgent care visits, multiple and unnecessary tests and referrals to costly specialists.   

“If we more appropriately direct care and manage preventative care,” Dr. Patel elaborated, “we will reduce the higher-complexity, higher-cost care – like surgeries and ER visits – to less-complex, less-expensive physicals and medications.”  
Better Access for Patients  
Additionally, patients have more convenient ways to access care in a Direct Primary Care model, like 24/7 telehealth services and same-day appointments. Some Direct Primary Care clinics feature expanded services, like on-site MRIs and prescription fulfillment, which increases convenience and reduces costs. As Dr. Patel explained it, “Access to care is critical in terms of offered value.” said Dr. Patel.  
More Effective Payment Methods 
Direct Primary Care providers pay for care on a per-member, per-month basis, as opposed to the traditional fee-for-service model. This reformed payment methodology rewards providers for quality of care, placing an emphasis on value over volume. There are no inflated costs due to third-party or fee-for-service billing because patients pay for their care directly to the physician. Most Direct Primary Care memberships/subscriptions cost less than the average cell phone bill, often for as little as $70/month. 

“I want to have more time with my patients,” Dr. Usher said plainly, “In the traditional health care world, you make more money with two 15-minute appointments than a single 30-minute appointment. That’s why we moved into a Direct Primary Care model.”  

Dr. Usher went on to explain that primary care is undervalued in traditional medicine due to the reimbursement structure in the fee-for-service model. “Primary care is often used as a referral engine to bigger, more expensive health systems,” he said. “For patients, this year’s charges become next year’s premiums – even with good insurance.”  

In fact, general deductibles have increased eight times faster than wage increases, and premiums have increased every year since 2008. These costs are causing patients to ignore symptoms and forego treatment on manageable symptoms until they become, what Dr. Usher referred to as, “medically homeless.” Ultimately, those patients will end up seeking costly emergency treatment when things get worse.  
Patients and Employers Prefer DPC  
However, the Direct Primary Care model combats those traditional health care inefficiencies by providing patients with:  

Better access to providers  
Deeper, trusting relationships with primary physicians  
Address root causes to health problems (not just symptoms)  
Produce fewer referrals and expensive tests  
Better affordability  
Better work and lifestyles providers  

As for employers, in addition to paying a simple monthly, per-member fee, they also experience reduced absenteeism due to happier and healthier workforces.  

Dr. Usher ended his presentation by explaining that by moving to the Direct Primary Care model, his patient satisfaction has skyrocketed: “This model is highly popular with patients who really enjoy the access to health care and more specifically, the lower costs.” 

In Dr. Patel’s closing remarks, he expressed that a good health plan heavily incentivizes direct-contracted primary care, and that employers need to take action for widespread acceptance. “As employers, you can make an impact as the largest purchaser of health insurance,” he concluded.  
Learn More 
For more information on our new Sun Prairie clinic or to learn what it takes to start your own on-site clinic, please contact your Account Executive or reach out to Business Development. 





In late April, The Alliance hosted their first Employer Town Hall. The e-conference roundtable was intended to provide a place for employers to share solutions and discuss the impact that COVID-19 has had on business operations. 

In addition to a panel of leaders from The Alliance on the call, we hosted two employer-presenters to lead the discussion and help facilitate conversation: Jim Sheeran, Sr. Director, Total Rewards at Molson Coors Beverage Company and Diana Clark, Benefits Manager at Promega Corporation. 

Both of our presenter’s organizations have initiated a COVID-19 task force, and in order to remain flexible and respond to changes quickly, Jim said meetings occur daily. “Our task force meets every morning, and every day at 4:00pm we have a leadership meeting which provides quick input from HR. We have an immediate feedback loop with union leaders which frames how we work as a task force.” 
Adapting to the “New Normal” 
Our presenters shared what tactics their businesses use to screen and test employees for COVID-19 and how they changed workstations, and even shifts in some cases.

For example, Diana said Promega’s normal operations occur in two shifts during a 5-day work week, and now they’re operating as a 3-shift, 7-day work week employer. This has been helpful in keeping production up-and-running while reducing the number of employees working to create the necessary separation that the CDC requires. She also said that taking simple measures like using painter’s tape to display separation requirements is successful in keeping coworkers safely spaced apart. 

Diana explained how they double-checked their benefit plan to ensure that telehealth was offered to their employees: “Physician visits were excluded in a telehealth setting due to the wording in our contract, so we reached out to the TPA to update the communication.” 

Molson Coors Beverage Company is a multi-national corporation who is well-equipped to deal with challenging operational situations, yet due to unprecedented conditions, Jim explained they’re reacting and trying new things like everybody else. 

“We put in temperature checks that were no-touch, but they didn’t work well because we didn’t take into account the heat from the employee’s environment,” he added, “People call in sick to our hotline for work. If someone called in Monday and Tuesday because they weren’t feeling well but came in on Wednesday and called in sick again on Thursday, we should’ve flagged them as high-risk patients and not had them come to work.” 

Diana said her team has initiated random exposure drills to help educate managers how be prepared. “We can run them through what a situation would look like if a specific employee were to get sick and how severe it would be in terms of potentially infecting other people. The drills help point out to managers the importance of following company procedures. “ 
Unintended Consequences 
Whether you want healthy employees to come to work or don’t want high-risk individuals showing up for their shift, Jim said incentivizing employees works, and it’s important to carefully think through incentives in order to not pay employees too much or too little. His organization gave a substantial pay-bump to their front-line workers and offered a “high-risk leave of absence” to employees.  
Catching COVID-19 
Diana offered several useful learnings through her experience over the past two months:  

Figure out what symptoms require separation from other people 
Screening for coughing, fever, and shortness of breath has been successful in catching a few cases. 
Know newer symptoms 
COVID-19 can manifest itself as the flu, a sinus infection, or with headaches and body aches. 
Develop an assessment and update it frequently. 
Promega uses their Human Resource Business Partner team to help triage patients; they have a chief medical officer, an RN, and six other officials who clearly communicate to symptomatic patients to not go to work and call their manager instead. 

Overall, Diana said their biggest goal is to keep people off campus if they are symptomatic. With the aid of their Medical Director, they’ve developed a protocol to call affected employees and ask them a series of questions to further determine their risk level. “We really stay in contact with our employee population. We’ve compiled a symptom checker that can be accessed through the patient’s computer or phone, and depending on how they answer, they’re either cleared for work or HR reaches out to them with next steps.” 
Avoiding Furloughs 
Navigating furloughs was also part of the discussion, and Promega has been creative in shifting job responsibilities to eliminate the need to furlough. For example, they have a large staff of cafeteria workers who are now contributing to the manufacturing/operations side of the business. “It’s been amazing to see people step up. They want to help and be utilized,” Diana said. 
Keeping Employees Safe (And Sane) 
As far as supporting remote workforces, she offered a few tips: “Our physical therapists are now doing tele-consults, helping people with lower back pain, setting up their home workstations, etc.”

Knowing its importance, both organizations offer mental health resources through telehealth. “We have an emotional-social mental health team that helps boost our Employee Assistance Program (counseling,) which helps spot people with addiction and depression. Creating check-ins and virtual lunches have been critical for our remote employees,” said Diana.
Communication is Key 
Both Jim and Diana also agreed that it’s not enough to ensure your employees are safe – they need to feel safe, too. By communicating protocols, posting flyers, and making constant announcements and reminders, employees will be more at ease about coming into work. Here are some ideas:

Use painter’s tape to direct employees to stay six feet apart
Use visual cues like signs to help facilitate proper safety, like washing your hands often and properly, coughing into a tissue, and wiping down frequently touched areas
Implement special visitation rules that include a screening and questionnaire 

Jim and Diana agreed that things are changing quickly, and employers need to be willing to adapt to those changes; both of their companies follow all CDC guidelines and are continually watching for new state-specific mandates. 

Stay tuned for our next Employer Town Hall, subscribe to our newsletter to stay up-to-date on upcoming learning opportunities, and watch for details on our upcoming webinar series about Direct Primary Care and how it can help your business.