Richard A. Mojares, MD, FAAP, FACP CEO, Medical Director Oakhurst, NJ

 Changes in Healthcare Environment: Affordable Care Act (ACA) and Healthcare delivery  Access to Care  What is an Urgent Care Center (UCC)?  What value can UCC bring to the WC and Occ Med industry?  Not all UCC are created equal

 Access to care  Shortage of Primary Care Physicians  Further expansion of the role of PCP (home)  Occ Med  Occ Health  Growing population of patients with greater healthcare needs  Increase in patients with insurance (ACA)  Emergency Rooms overcrowded

 For those patients with a PCP  57% patients report access to same day or next-day appointments  63% report difficulty getting access for care on nights, weekends, or holidays w/o ER  20% waited 6 days or more to see their Doctor

 By 2020, shortage of 46,100 Primary Care Physicians  Study 2011, Association of American Medical Colleges (AAMC)  AAMC predicts a shortage of 45,400 doctors from other specialties by 2020  Unlikely to change if the cap of Medicare- funded residency slots is not lifted, according to AAMC, AMA and others

 By 2025, the over 65 population will grow to 80 million, further straining the primary care burden.  Baby boomers

 Increased number of insured patients  Provides healthcare coverage for a NEW GROUP of about 32 Million individuals  This model was done in Massachusetts and showed that the primary care offices were overwhelmed.  Mass Gen has their own Urgent Care

 PCPs incentivized to improve care Increased coverage  3.1 million bet/ ages added to parents ins  Pts with pre-existing conditions  Increase Medicaid pts, for pts who can’t afford ins  Reduced healthcare costs, preventative care will be more affordable  Small businesses required to supply affordable ins to employees, or get fined, get tax benefit

 Shortage of Healthcare Professionals  Office visits to PCPs will likely increase from 462 million to 565 million by 2025  Possible higher drug costs, Pharmaceutical companies will pay 84 billion in order to close the donut hole and may pass expenses to the consumer

 Patient Centered Medical Home (PCMH)  “Whole person” and “Whole Population” orientation  Accountability for quality improvement through performance measures  Utilize information technology  Integrated and Coordinated care  Provide “enhanced access” to care (i.e. extended hours, open scheduling, walk-ins, communication with pts)

 Accountable Care Organizations (ACOs)  Makes Physicians and Hospitals More Accountable  Outcomes oriented, performance based with aligned incentives  Goal: Improve value of health services, control costs, improve quality  ACO’s share in a portion of any savings gained

 Majority of nation’s ED report they are operating “at or over” capacity  ED visits hit a new high in 2008 and continues  Up to 124 million  Number of ED’s falling (hospitals closing)  ED visit rates increased at twice the rate of growth of the US population  Increased emergency visits by the elderly  Average ED visit times increasing to over 4 hours

 Several state Medicaid directors have begun organizing state-funded programs to reduce ED visits used for Primary Care  National and regional studies from  8-57% of ED visits were for non emergencies

 Freestanding Emergency Rooms  Blended Urgent Care Centers/Occ Med  Convenient Care Clinics (NP staffed)  Retail clinics (i.e. Minute Clinic of CVS Health, Take Care Clinic of Walgreens)  Telemedicine (Outpt-MeMD, eICU, Occ Med)  Concierge Medicine  Hospitals are pushing all care to outpatients, and developing more ambulatory centers

 Employer communities are affected  Large percentage of Americans receive health benefits at work (137 million employees in US)  Increased awareness of health of employees and dependents (increase productivity and lowers health related costs)  Work impacts health and health impacts work

 Occ Health is the focus  Occ Health providers are important  Occ Health and wellness initiatives now reach millions of workers  Emphasis on prevention  Health and population management

 Ambulatory center that treats non-life threatening conditions  Occupational Medicine, Worker’s Compensation, Drug Screens  No Appointment necessary, Walk-In  Extended hours and weekends  Capable to treat Adults and Pediatrics  Procedures:  IVF, Sutures, Splinting, X-ray, Labs, IV/IM Med, I&D, Oxygen, ear irrigation, wound care

 9,000 centers throughout the US  Location:  25 % Urban, 50% Suburban, 25% Rural  Doctors:  55% Family Practice, 22% ER, 15% IM  Wait times:  57% less than 15 min, 36% bet  Ownerships:  50% physician, rest is Corp (i.e. Concentra) or Hospital

 Concentra (300) and US HealthWorks (150)  have come into the Urgent Care space  Initially strictly occ med clinics, now providing Urgent Care  Now extending hours and weekends  Providing community Urgent Care for adults and pediatrics  Experienced a culture change

 Open evenings and weekends  Episodic care (injuries) including drug screening  X ray and Lab on site  Pre employment physicals (episodic)  Community care for employees and families  Strep tests, splints, Flu and Flu shots, cough and colds

 Conveniently located in residential, high traffic, store front, near industry  Coordination of care (Wellness) referral to specialists  Customer and patient satisfaction focused  Treats community patients and workers

 Cinema theater, popcorn maker  Coffee, snacks, drinks  Call backs  NPS scoring and Customer satisfaction

 Certified with UCAOA  Evenings and weekends  X ray and Lab available  In network with your insurance company (WC or Private)  Adult and Pediatric capable  Established relationships

 Primary Care/Urgent Care  Occupational Health/Workers’ Comp  Occupational Health/Population Health  Commercial Insured/Self Insured