P.O. Box 180037
1000 Fianna Way
Fort Smith, AR 72918
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EHC News Archive

Table of Contents

November 3, 2008 –

The company infirmary is making a comeback.

See this complete article at www.arkansasbusiness.com

Decades ago, it wasn't unusual for large factories to have a company nurse or doctor who could see to the medical needs of employees while at work.

With health care and insurance costs increasing by as much as double-digit annual rates, large employers are rediscovering the advantages of providing on-site medical care to their workers.

Studies by the National Business Group on Health and Watson Wyatt Worldwide estimate 23 percent of large companies (1,000 employees or more) provided some on-site care in 2007. That figure was expected to grow to 29 percent in 2008 and to 32 percent by 2009.

IMWell Health LLC, with most of its business in the Fort Smith area but with a reach stretching from Oklahoma to Hot Springs, is part of that growth curve.

IMWell Health debuted in 2005 with an initial focus on wellness counseling that quickly expanded into general medicine. From 2006 to 2007, IMWell doubled its employees, patients served and revenue.

The company, owned by Dr. Catherine Womack and Dan Parker, now has five dedicated, on-site clinics at employers such as OK Industries, Weldon Williams & Lick and Riverside Furniture in Fort Smith. IMWell has grown to 30 employees, including two full-time doctors, a part-time doctor, four nurse practitioners, a physician's assistant, six LPNs and one RN.

It also has free-standing clinics in both Fort Smith and Hot Springs that exclusively serve the employees, spouses and dependents of smaller companies in the area for whom an on-site clinic is impractical. By pooling resources with other small businesses, companies now have access to lower cost care without sacrificing quality and productivity.

IMWell's first clients were brought to Womack by Caryol Hendricks and the Employer Health Coalition, a Fort Smith-based organization of self-funding companies. Self-funded companies pay all of their employees' medical bills rather than use an insurer such as Arkansas Blue Cross/Blue Shield.

The EHC was banded together to do price-based negotiations with Fort Smith-area hospitals and Hendricks approached Womack when she heard the general practitioner was interested in starting a company that performed wellness and chronic disease management.

Joint Effort

After seeing and counseling several employees on wellness, disease management and preventative care, Womack began hearing a familiar refrain as she sent patients off to see other doctors.

"After a while, it was always, 'Why can't you just treat me?'" Womack said. "That's when I went to the employers. It really evolved from watching these poor people not have access to health care."

From there, Womack said, it was a matter of process: putting clinics in place, finding out from employers what their medical needs were and finding access to providers and affordable medicines.

"It has really mushroomed over the years," said OK Industries director of benefits Mike Evans. "Back when we [the EHC] first started looking, on-site care wasn't nearly as popular or well known. It was not an idea on most companies' radar screens at the time."

National companies that provided on-site care required a minimum of 2,000 employees to be cost effective. While Fort Smith is a manufacturing hub within Arkansas, most of its factories don't meet that threshold.

"It worked out that Dr. Womack started working with members of the Coalition and it became a joint effort," Evans said.

Parker, the company CEO and a 50-50 partner with Womack, said IMWell now serves approximately 12,000 employees and 30,000 overall counting spouses and dependents who are also eligible to use the clinics. IMWell also has an on-site clinic at the University of Arkansas-Fort Smith that serves an additional 6,000 students.

The company is now eyeing both Northwest Arkansas and central Arkansas for future growth. Womack lives in Fayetteville, Parker in Little Rock. Parker said the key to expanding into either market will be securing an "anchor client": a company large enough to make it cost effective to move into a new area.

IMWell has been focused from its start on cash flow, Parker said, and its only initial start-up expense was payroll.

"I was able to get our initial customers to pay for the equipment, reimburse us for out-of-pocket expenses, furnishings, supplies," he said. "All we had to do was hire people."

About a year after starting its first on-site clinic, Parker said IMWell used Regions Bank for a line of credit to handle fluctuating payroll and to eventually purchase and build out its free-standing Fort Smith clinic.

Parker said a $475,000 loan from Regions covered the startup costs of the Fort Smith facility that covered all equipment, furnishings and the building purchase price.

Cutting Costs

Various industry studies of on-site care report that the return on investment can be dramatic. The low end of ROI is $3 for every $1 spent and some put the number as high as $5 to $6 in benefit for every $1 spent.

Some on-site clinics can be set up for less than $10,000, Womack said. From there, the pricing for services is negotiable. "Some have flat rate," she said. "Some pay per month, some hourly, some get a discount off service. That's where my business partner [Parker] comes in.

"I go in and tell him how many people they need staffing the clinic. Depending on their budget and what they want to provide, we say, 'This is what we think you should start off with.' You want the ability to expand and add people on. You also want to make it cost efficient." Some savings are still being measured, such as comparing productivity, workman's compensation claims, absenteeism and a new term "presentism," which refers to workers who are present but unproductive because of illness.

Riverside Furniture saw its health care costs decline by 17 percent from 2005 to 2006 after installing an IMWell clinic. Its costs declined another 5 percent from 2006 to 2007.

In Hot Springs at ChemFab, costs per employee declined by 22 percent from 2006 to 2007.

The anecdotal evidence is even more powerful.

One older gentleman Womack saw at Riverside had a blood pressure reading of 240 over 130. It was so bad, Womack said, that she could see burst blood vessels in his eyes.

The man was on the verge of a stroke and when Womack suggested as much, he told her he couldn't go to the emergency room anymore because he owed them too much money.

Womack asked him if he could afford a $4 generic drug from Wal-Mart. By the next week, his blood pressure had declined dramatically and through wellness counseling he eventually lost 40 pounds and stopped drinking.

A previous stroke for a Riverside employee cost the company $100,000, Womack said.

Another example was a diabetic who couldn't afford the testing supplies and only took insulin when he "felt bad." Tests showed he had high blood sugar and his kidneys were beginning to malfunction.

Within three years he would have likely been on dialysis at a cost of $60,000 per year. If he'd been fortunate enough to qualify for a kidney transplant, the cost would have been between $100,000 and $150,000.

"What tends to drive costs are the more significant cases," Parker said. "You can't do anything to change the trauma of a car wreck. Our biggest influence is in managing chronic disease. We provide easy access to good care and keep you out of the emergency room or from a stroke or other significant event.

"That is going to have a positive impact on what [employers] are spending."

Womack calls Wal-Mart's $4 generic program launched in 2006 a "God send," and noted that some generics that cost more than $50 when she first set up at OK Foods are now on the $4 list.

For managing chronic diseases like high blood pressure and diabetes, Womack says she can often find the drug she needs on Wal-Mart's ever-updating list.

"I've already checked the list four times today," she said. "Seventy-five percent of the medicines that are filled are generics." Womack, unlike many providers, doesn't automatically refer patients for expensive ancillary services like MRIs or CAT scans.

"The classic case is a headache and the person wants a CAT scan," she said. "And I'll say, 'These are tension headaches. Let's try treatment for a week and if you're not better or you're worse, I'll order it.'Usually they come back the next week feeling fine."

Womack also uses Wal-Mart's pharmacy services to track employee purchases. If someone isn't getting his or her prescription filled, the employer can be notified.

"You can chase down noncompliant patients," she said.

The real cost savings, Evans said, are difficult to measure.

"To keep costs comparable was the goal," he said. "We've achieved that and actually done somewhat better. But we also recognized the initial dollar cost was not the actual savings we'd garner from program.

"The real savings is in the goodwill of employees — the care they're getting and knowing they're getting good care. The goal is to take care of the whole person, not just what's wrong with you today."

October 1, 2008 –

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The Employers’ Health Coalition (EHC) Refuse to Misuse Antibiotic Campaign kicked off on Wednesday, October 1, 2008 and will run through the end of the year.  Antibiotic over use and misuse is a major public health concern locally and throughout the country. This campaign is a win-win for everyone. 

Working with area physicians, hospitals, county health departments, IMWell Health onsite medical clinics and EHC member companies, EHC will provide practical healthcare information throughout the greater Fort Smith and Hot Springs areas.  Community awareness and educational materials will be provided using a variety of resources developed by EHC, the Center for Disease Control (CDC) and other sources.  EHC’s educational campaign will utilize printed materials, mass media messages and increased communications between physicians and patients.

When implemented in other parts of the country, data has shown a significant decrease in antibiotic use after the campaign. Besides decreasing the likelihood of developing antibiotic resistance, the decrease in unnecessary use of antibiotics allows our health plans to focus our limited financial resources on treating hypertension, diabetes and asthma where the cost/benefit ratio is always high.

This program is a great opportunity for the Coalition to show a leadership role on a community level, showcase the need for better education on value based healthcare issues and ties directly to our mission of improving the health and quality of healthcare among our employees and the communities we live in

September 24-26, 2008 –

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Wow, what a conference!

The FIRST Employers’ Health Coalition Annual Conference finished up mid-day on Friday, September 26, 2008 with overwhelmingly enthusiastic comments from attendees who were “amazed” at the quality of the speakers, topics and information.

Truly, the speakers were the preeminent leaders in their areas of expertise; most notable, Joe Thompson, MD MPH, Arkansas Surgeon General and Mark Fendrick, MD, the architect of Value-Based Healthcare. The previous day Dr. Fendrick was meeting with Secretary of Health and Human Services Levitt and key advisors to the McCain and Obama campaigns at the National Institute of Health in Washington, DC. Andy Webber, CEO of the National Business Coalition on Health, Jerry Custer, the founder of Refuse to Misuse and several other great speakers completed this elite roster.

VALUE BASED HEALTHCARE, this year’s conference theme, was a somewhat unfamiliar concept to most attendees. But acceptance of the key tenants expressed by the thought leaders and the simplicity of the model seem to really take hold in the minds of the attendees. Removing barriers to care and paying for HEALTH; what could be simpler?

Just as exciting was the broad spectrum of attendees which included representatives from local and state government, hospital and physician group leaders from across the state, physicians, educators, clergy, health plans, repricers, pharma, PBM’s and, of course our members from Fort Smith and Hot Springs and other non-member employers.

A special note of thanks goes out to all of our sponsors and exhibitors. Congratulations to all the winners of sponsor door prizes, and especially to Bev Gillstrap from the University of Arkansas Fort Smith, the winner of the 42 inch LCD television. We look forward to a bigger and better conference (and seeing you there) next year.

May 9, 2008 –

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Leading the Transformation of the Healthcare Delivery System!

On Wednesday, May 9, less than a year after launching his Value-Driven Health Care Initiative, Health and Human Services Secretary Mike Leavitt held a roundtable with key business, union, government, community and health care leaders. He announced a major milestone: more than 100 million Americans are now served by health plans that are committed to the four cornerstones supported by Medicare and federal employee benefit

Secretary Leavitt stated “We are organizing the health care market to achieve better quality health care, at lower cost, for all Americans. That is the definition of value,” Secretary Leavitt said. “Yet until now, our health care system has been marked by a lack of consumer information to support value-based decisions.”

Employers’ Health Coalition, represented by their Executive Director Caryol Hendricks, participated in the roundtable as a nationally recognized organization of business leaders actively engaged in supporting value driven healthcare.

Hendricks said, “ It was an honor for the coalition to be invited to participate in this important roundtable discussion.  Value is a combination of price and quality.  Employers must give equal focus to both when purchasing healthcare for their employees and their families. 

Secretary Leavitt continued to discuss progress toward a value-driven system at an event last week in Philadelphia. At the meeting, which was sponsored by the National Business Coalition on Health, Bridges to Excellence, and the Leapfrog Group, he spoke about the key role that employers are playing in the value-driven health care movement. 

Caryol Hendricks also spoke at the event.  Ms. Hendricks addressed the need for electronic medical records in physician’s office and how to overcome the obstacles physicians face in making the change.

Hendricks said” There is no doubt that the use of electronic medical records saves lives.  The most conservative estimates are 44,000 to 98,000 lives saved per year.  However, implementing this important tool in a busy office practice is challenging.  Through one of our key quality initiatives, Bridges to Excellence, our leading employers will financially reward participating physicians for implementation of electronic medical records.  The employers supporting BTE are Boyd Metals, Butler and Cook, Cloyes Gear, Kopco, Ok Foods, Riverside, Weldon Williams and Lick and Whirlpool.

February 12, 2008 –

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Fort Smith Employers Share Health Care concerns with Presidential Candidate Mike Huckabee

Two Fort Smith based employers met with Presidential Candidate Mike Huckabee at the recent National Business Coalition on Health’s Annual Conference held in Scottsdale Arizona this week.  Mike Evans from Riverside Furniture and Bob Dornblaser from OK Foods as well as Tom Hare from Triumph Fabrications of Hot Springs, spent approximately 45 minutes in a private session with Mr. Huckabee.   Caryol Hendricks, the Executive Director of the Fort Smith based Employers’ Health Coalition also participated in the session.  Hendricks stated, “ the session gave us an opportunity to share both our experiences and insight regarding the healthcare situation in our state with the Republican Presidential candidate and former Governor of Arkansas.”  Dornblaser was impressed with Huckabee’s knowledge of the current state of healthcare in America. “ We discussed value based purchasing of healthcare and our concerns regarding government run healthcare.”  Evans agreed and felt that the Governor had the right message for his audience. “It was reassuring to hear that Mr. Huckabee understands that the healthcare delivery system is broken and must be redesigned”.

Huckabee gave the keynote address and Hendricks was a speaker and facilitator at the conference.  This year the program featured real-life examples from employers, business, health coalitions, health plans and communities that are striving to purchase high quality, more affordable and more efficient healthcare services. 

January 28, 2008 –

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Employers’ Health Coalition (EHC) Awarded Grant from
National Business Coalition on Health for Diabetes Quality Program

Funding enables expansion of the Bridges to Excellence Diabetes Certification Initiative

The non-profit Employers’ Health Coalition announced today that it is receiving funding through the National Business Coalition on Health’s (NBCH) Diabetes Seed Grant Program to further its efforts to improve diabetes care in the Fort Smith area. Launched with funding from Novo Nordisk, with additional support from Merck, Pfizer and sanofi aventis, the grant program was established to assist coalitions throughout the U.S. in implementing and evaluating models for improving diabetes care at a community-level.

“NBCH is pleased to support our member coalitions as they do the important work of convening market stakeholders around the treatment and care of employees with diabetes,” said Andrew Webber, president and CEO of NBCH. “We congratulate the Employers’ Health Coalition for their efforts to improve the quality and efficiency of care for patients with diabetes.”

“We appreciate the support from NBCH as we work to improve the health and reduce the long-term health care costs and improve productivity for employees with diabetes,” said Caryol Hendricks, Executive Director of Employers’ Health coalition. “Through collaboration at a community level and engaging all health care stakeholders we are working to assist physicians in their effort improve the health status of their diabetic patients.”  Hendricks said  “we plan to work with the University of Arkansas for Medical Sciences to tailor a program specific to the needs of the physicians in this area.”  NBCH will support member coalitions with evaluation and technical assistance to measure and report the results of these programs.