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HERYL HARDIN HAD A MIGRAINE THAT WOULDN'T QUIT. But when she called The Emory Clinic to make an appointment, she faced a different headache–the earliest available datewas more than a month away. “Too long to wait and to go withoutmedication. ” the Emory University Hospital nurse recruiter notes.
     New to her current job, she remembered learning in orientation about a program that helped Emory employees coordinate care with Emory health providers.
     The Emory Employee Access line, launched last January, allows employees to call a special phone line for assistance with scheduling.
     “I was amazed at how well it worked,” Hardin says. “I called the telephone line and spoke with a nurse at HealthConnection, who called several people and kept me informed of the process while she was working on an appointment.

       The access line was the earliest and most visible step in a more than yearlong effort to encourage more faculty and staff to seek care within Emory’s own health system.
     The process is a natural effort to extend the benefits of Emory’s progress to the very people who make it possible, says Donald Brunn, The Emory Clinic’s chief operating officer. The clinic has seen a tremendous growth in capacity in the past two years and is making a concerted effort to ensure that members of its own community share the rewards.
      “We have seen impressive growth in the number and depth of our physician faculty, particularly with the development of the Winship Cancer Institute, a new orthopaedic and spine center facility, and new outpatient diagnostic capabilities in digestive health and radiology. Our revenues have increased 10% to 12% each of the past three years,” he says. “Around this time last year, however, I noticed that we had been doing a great deal of outreach and communication to the public about the growth and the opportunities for care here, but we had done very little outreach to the Emory community. We needed to reach out to our Emory family, and we needed to be focused about it.”
     Since learning in late 2003 that Emory Healthcare (EHC) was providing care to Emory employees only about half the time that it could, administrators stepped up efforts to improve access—clinic section schedulers were instructed to give Emory employees top priority, the access line assistants paved the way to faster appointments, and an educational campaign touted the state-of-the-art care available.

In September 2003, two Emory Healthcare marketing surveys revealed that concerns about confidentiality and difficulty in obtaining timely appointments were key reasons employees sought care elsewhere.
     In an initial survey of 3,743 health system and university employees, respondents ranked Emory either “better than” or “as good as” other health care providers on all criteria except ease of scheduling and appointment availability. In the last category, 23% ranked Emory as “much worse” than other providers.
     A second survey of former participants in the Woodruff Leadership Academy found that 38% were “very concerned” about confidentiality of their health information when receiving care from their health care provider, while 33% reported that they were “somewhat concerned” and 29% were not concerned.
     Almost 16% of respondents said that confidentiality concerns had been a factor in their decision to seek care from non–Emory providers.
     The information gleaned from the surveys told administrators that they must aggressively address scheduling difficulties and that they needed to do a better job of educating employees about the health information privacy protections that were in place.
     Respondents in the first survey overwhelmingly indicated that they would use a program like the employee access line and that it would influence their decision to use Emory providers, says Una Newman, director of marketing for EHC. “So, we developed dedicated phone numbers for each clinic section for employees to use for making appointments. But we didn’t stop there. We also created a backup advocacy line, which could be used if employees felt that they did not receive a desired response from a clinical section.”
     The issue of confidentiality, however, was trickier.      Health system employees are often faced with a conundrum. If they use their employer as their health care provider, will their boss end up with information about their medical condition? And will their co-workers know when they go to the doctor?
     “We wanted to find out whether the concerns were an issue of ‘Will someone see me at the doctor’s office?’” she notes. “Or, were they concerned about the true confidentiality of their medical information? Could someone get to a computer and look them up?”
     Responses to the second survey indicated that while some people just do not want to receive medical care from their employer, most of the people concerned with privacy were worried about the issue of unauthorized access to their medical records, a more serious problem, she says.
     “We care a great deal about that concern,” Newman says. “We cannot overstate how seriously we take the issue of privacy of medical information. We have strict measures in place to protect patient confidentiality. We will fire people who violate those policies.”
     The clinic has risen to the challenge of addressing the scheduling issue, says Brunn.
     “Many people have long-held beliefs that getting an appointment at The Emory Clinic in a timely way takes having a special connection or a physician’s referral. This is no longer true,” he notes. “We have the support of each department chair to make certain that Emory employees have top priority access to their clinical areas. We are determined to get out the message that The Emory Clinic is open for Emory business and that we want to care for them. Emory faculty members, staff, or their families go to the head of the line when they identify themselves as part of the Emory organization.”
     There are limits, Brunn admits.
     “There is no way to guarantee access to specific providersat specific times of day or days of week without expecting a long delay. And some of our senior faculty are no longer accepting new patients,” he explains. “But our schedulers are trained to offer next-available appointment access with any one of numerous faculty in any given specialty area, and all of our faculty are of the highest quality.”
     To provide top-quality care to the community at large, Emory should first ensure that its own employees receive the best treatment, Brunn emphasizes. “To the extent that we’re able to do well by employees, we’ll be able to do even better by all the rest of the patients.”
     Emory employees serve as an important bellwether for how well the health system serves all of its patients, Newman agrees, noting that the employee surveys provided valuable information about how often respondents received recommended diagnostic and screening tests, such as mammography.
     “Employees are a good audience in terms of our ability to ask questions about their care,” she says. “The answers we get help improve care for everyone.”

The issue is about more than just self-improvement, however. Stemming the flow of health care dollars tocompeting providers is also important, notes John Fox, EHC’s CEO.Emory University and Emory Healthcare both self-fund their health plans, he explains. Unlike some companies, which pay premiums to outside insurers to cover the cost of health care for their employees, Emory contracts with insurance companies only for administrative services, such as recordkeeping and filing of claims. The costs of employee health care are paid directly by the university and EHC. It costs significantly more money to pay for care provided outside their network.
     “You have to consider that, for each procedure or service, there are fixed and variable costs,” Fox explains. “If we pay $2,000 for someone to have an MRI done at Piedmont, that charge includes both the costs of that individual patient encounter, plus a percentage of the cost of Piedmont’s purchase and maintenance of the MRI equipment.”
     The same MRI performed at Emory would cost the university and EHC plans about half as much because EHC has already absorbed the fixed costs of the equipment.
     Although employees are sometimes under the impression that added expenses are absorbed by some “big insurance company,” the fact is that Emory writes the check for all health care provided to employees, Fox says. Extra money spent on outside care is money that is unavailable to support research and new technology here.
     Claims data for university and health system employees for 2003 indicate that the total amount of care from non-Emory providers that could have been provided by Emory totaled $22 million.
     “We are in a common situation for major health systems in that we are both a health care provider and
employer providing health coverage. We both provide it and fund it for our employees,” Fox notes.
     In the face of skyrocketing health care costs, Emory is going to have to become more prudent in the use of its resources, Fox says.
     In the coming year, the university and EHC expect to spend $17 million more on employee health care than they did last year.
     They are not alone.
     The rising prices of new pharmaceuticals and new medical technology are pushing the costs of employer-sponsored health coverage through the roof nationwide. Many employers are shifting more of the payment burden to their employees, dropping health coverage altogether, or using more temporary workers instead of filling permanent positions.
     No such plans are in the works at Emory, says Fox. For this fiscal year, the employee portion of health plan premiums remained the same as last year. The health plans did increase the co-pays that employees pay for seeing out-of-network providers.
     “We are committed to providing employees high-quality
medical benefits while keeping costs affordable,” says Fox. “In fact, we did not increase full-time employees’ health care premiums in 2005—despite national trends to the contrary.”
     However, Emory may be unable to hold the line for long.
     The total cost of employee health care for 2003 was just over $77 million, more than double what it was five years ago. If costs continue to increase at the current rate or faster, the current health plans could become an untenable burden.
     “Emory and Emory Healthcare are close to spending $100 million annually on health care, and that is not sustainable,” says Fox.
     The solution lies not in simply cutting costs wherever possible but in ensuring that Emory employees get the highest quality care delivered in the most efficient manner, he adds.
     For example, pharmaceuticals are one of the biggest expenses of any organization’s health plan and one of the fastest growing. Last year, Emory implemented a new pharmacy plan design in an attempt to control the 16% to 20% annual cost increases in prescription drugs. Employees are charged lower co-pays for generic drugs and brand name drugs offering equal or greater therapeutic value and cost-effectiveness compared with other drugs in the same drug category.
     “The recent increase in direct-to-consumer pharmaceutical marketing has led to patients seeking brand-name drugs that often do not work as well as other drugs for their condition,” Fox notes.
     Emory must also do more to encourage employees to use Emory providers whenever possible, he adds, acknowledging that the health system has some adjustments to make on its own.
     At a time when the entire country is struggling with how to provide and afford good health care, Emory has the potential to be a pioneer both on the provider and payer side by improving quality and efficiency and effectively reining in expenses.
     “We have to be competitive, and we have to offer employees a reasonable network,” he notes. “If you live in Henry County and you need a general pediatrician, you can’t come up here to take your child to the doctor, and we have to do something about things like that. We are also going to have to get much more serious about controlling health care costs. Our goal is to be a model of providing affordable, high-quality, efficient health care for everyone.”

Catherine Harris is the editor of Momentum.

  Getting an appointment sooner

Emory Employee Access is a two-tiered process designed to ease appointment scheduling for faculty and staff of the university and health system.
     Employees start with the traditional route, by calling section schedulers. However, they should also be sure to identify themselves as an Emory employee at this point. This will ensure they are given priority in scheduling appointments.
     If the scheduled appointment time is still unsatisfactory, the employee should proceed to the
second step and call the employee access line (404-778-EVIP [3487]). A nurse there will help coordinate a visit with an appropriate Emory provider.
     In most cases, an earlier appointment can be arranged.
     An analysis of the calls to the EVIP line from the first two quarters of operation indicated that of the 18 times that employees called requesting an earlier appointment, schedulers were able to accommodate that request 17 times. During the first two quarters of operation, the line received 155 total calls, with most of the callers requesting basic information about providers or seeking to establish a new primary care physician.
     In addition to using the EVIP line, employees can find a list of physicians by specialty by visiting Emory Healthcare’s website ( or by calling Emory HealthConnection (404-778-7777 or 1-800-75-EMORY).


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