Good morning, friends and colleagues, I see friends here in the audience. I'm very happy to be introducing this session and our speakers to expand upon more traditional occupational health services and provide as well personal health services right where people work can be very challenging. And this has been a discussion among several members of the college for many years. However, inspiring leaders and employees around the possibility, innovating and partnering and collaborating, a word we used earlier today, and I think we're going to be hearing more about that throughout the next year, was the key to the launch and growth of easy care at the Yale New Haven Health System in Connecticut and Rhode Island. Today's speakers are Brianna Cannata, who is the Senior Population Health Administrator, and Dr. Ryan Pastena, a very inspired preventive medicine and occupational medicine physician. They strategized and delivered a pilot program at one of our system hospitals, which now per the chief clinical officer will be the system standard. So thank you for attending the session, for your passion, of course, around employee health delivery, for innovating, and be sure to take, we'll be sure to take time for questions at the end, but we'll remain for discussion as well. So thank you. Over to Brianna. Thank you. Thank you very much, Dr. Thorne. Good morning, everybody. I know we're a small but mighty group here, so we appreciate you sticking it out with us. It's Dr. Pastena's my honor to be here today to present on easy care for you today. So title of our session, Thinking Big and Expanding Employee Health Offerings, how Yale New Haven Health is helping our employees bridge gaps to primary care and disease management through easy care. We have no disclosures. So I just wanted to include a few slides to orient folks a little bit to Yale New Haven Health. We came from Connecticut over the last few days. So we have five hospitals, Yale New Haven Hospital in New Haven, Bridgeport, Greenwich, Lawrence Memorial, and Westerly Hospital in Rhode Island, 2,600 licensed beds, just about 150,000 inpatient cases, 3.5 million outpatient encounters, and about 30,000 employees that make it all work and run, about 7,500 of them being our medical staff. And we're also very proud of our academic affiliations with the Yale School of Medicine and our System Physician Foundation. Just a little geographic map of where we're spread out with our hospitals and our outpatient multi-specialty locations and programs that we deliver throughout the state. And that we're also very proud to be an employer and provider of choice in the region. So to jump into a little bit more about easy care and the strategic vision and concept, we began this whole process in about the summer of 2021, coming out of one of the waves of COVID. And as you have all seen, employees just had been through it. So it was really, really important to us to focus on taking care of our employees, because they took such good care of our patients throughout that trying time. So really wanting to create something to empower them to be actively engaged in their health and well-being, and offering an on-site service right where they work that's convenient, works in partnership with their regular sources of care, and for it to have no out-of-pocket costs to them. So it was really important to us to have that sort of low barrier to access. And it really is to expand access. We experience it throughout the health system. And I'm sure many of you experience it as well. Access is just such a challenge for so many folks into seeking care. So that was the overarching vision that we had for this program. So within our design team, we had a smaller sort of core leadership group to sort of set out what services we wanted to include. So it was really intended for treatment of minor personal illnesses and injuries. So unrelated to the workplace. Some non-work-related vaccinations for shingles and pneumococcal. And really helping to bridge gaps and create connections to our existing employee benefits and programs, some of which are employee family resources program. We have a care management and health coaching program called Living Well Cares. We have patient resource coordinators that our employees and health plan members have access to who are very well-versed in the preferred primary care specialty network that we have tied to our medical plan. As well as community health workers and some of our other services like our video care on-demand telehealth service and our HR connect services as well. And then we also had set out in the vision to include biometric screening as well. When it came time to decide where to start, where are we going to test this out, we took a few different items into consideration. First was looking at our data. We looked at our claims data for our health plan that has about 40,000 members on it. About 28,000 of which are our employees. So we looked at our employee-specific data to see how they were utilizing the emergency department. Because we found very often that employees who are working on-site would just go down to the ED and utilize that service instead of seeking out other sites of care. And we also really wanted to take into consideration the available capacity of the occupational medicine clinics at each of our delivery networks. So who has the capacity, who has the staffing that would make this the most successful endeavor. It ultimately led us to our Greenwich Hospital location as being sort of the ideal state with those avoidable ED numbers. And then they did have the capacity to take this on in addition to the occupational medicine responsibilities that they had. At that time, a couple of years ago, we also set up Bridgeport Hospital as a potential next option if we were to expand. So in taking that vision, we started to create our framework and our business plan to start bringing it around to socialize to different leaders and to begin the buy-in process. So it was really important for us to get the buy-in from the Greenwich Hospital leadership groups, our human resources department, as well as our finance colleagues. We were very pleasantly surprised that the Greenwich Hospital leadership and the president there was so excited about it, received it very positively, couldn't wait to have this accessible to her employees. Working with our human resources colleagues, it was very important for us to convey the business plan to them, because we were going to be tapping into their budget to fund this pilot. So they needed to understand the value and the benefit. Obviously, they understood all the great benefits to employees, but also that we were going to be targeting a reduction in ED utilization, as well as a shift in site of service for some of those vaccinations to generate a savings to the health plan. And so we were very pleased that they were also on board. To look at the sort of expense side of the pilot, we were leveraging a current occupational health space and staff, so we were not in need of recruiting for additional staff members or having to outfit the space to meet our needs. So we were lucky that that was already in place for us and wouldn't incur any incremental expenses. But we did estimate and set our business plan to not exceed about $30,000 in expense, primarily due to shifting the labor expense from those staff members at the clinic who were dedicating some of their time to easy care, as well as additional medical supplies, medication, vaccine inventory, and some other testing supplies. I also want to note, while we have been able to quantify some of the savings from those shifts in avoidable ED visits and non-work-related vaccines, we also really wanted to show what the employee out-of-pocket savings would be as well, because we're offering it at no cost. That's money back in folks' pockets that they wouldn't have to spend on a copay or other coinsurance and deductible costs. And then we also wanted to provide some of those indirect benefits. We haven't been able to quantify them, but our intention would be that it will improve lost productivity. Folks don't need to take half a day or a whole day off of work to go seek care elsewhere off-site and improve absenteeism. So some of the additional key program elements of easy care. We do make it available to all employees, regardless of their insurance status with our medical plan. Our HR colleagues, we're still very much on board with saying, open it to everybody. Don't limit it just to health plan members. About 75% to 80% of our employees are on our medical plan. So more often than not, somebody who's on the health plan is walking in the door. But we didn't want to create that barrier or that differentiation. As I mentioned, zero out-of-pocket costs for what we've deemed our sick or vaccination visits. But we do inform them that if they are referred on for additional lab testing or radiology or are written a prescription, that that will be subject to their health plan. Another item that has been incredibly important is the documentation in EPIC. Since we're using an existing site of service, an existing staff, and an existing infrastructure, our AHRQ med teams utilize SysDoc for their work. So for this service, which is intended for personal health care use, it was very, very important to us to create that firewall, that differentiation, that none of that would be documented in SysDoc in their employee record. And it would be maintained in EPIC and in MyChart, which is used across the health system. So people feel confident in knowing that their personal health care information is kept confidential, it's kept safe, it is not shared with their manager. And they have access to it later because it's part of their medical record. As I mentioned, the patients will come into the existing occupational medicine clinic space and see that same staff that they're used to seeing if they need to come in for a physical or a return to work or a workplace injury. So the staff there is currently one APRN, and we have one sort of dual front desk staff MA who work together to run the clinic. So they wear their Occ Med hat, and then they take it off and do an easy care visit over the course of the day. So it has been a learning curve for them to sort of vacillate between the two over the course of the day. But we do have a self-schedule mechanism that we did build through MyChart that people can self-schedule into our predetermined schedule. It was important to us to sort of create a predictable schedule around some of the existing work that they have and taking into consideration. You don't know what workplace injury might walk in the door. So wanting to help reduce walk-ins, so they will accept walk-ins if needed. We started out with offering four sick visits and one vaccination appointment per day up until February, and then we did add a couple of additional sick visits. When we were starting out the process, we weren't sure if we were going to have people down the hallway trying to get in or nobody showing up. But I think what we found is that there's just kind of a nice balance of folks coming in throughout the day and throughout the week, and it hasn't been too incredibly overwhelming for them to take on the additional patients into their workload. So I'm going to take a pause and pass it over to my colleague, Dr. Pastana. He is going to speak a little bit more from a high level of evidence to support the model in general, and then I'll come back and share some more of the numbers associated with the service. Thank you. Thank you, Brianna. And so what evidence did we use to support our model when we presented this to leadership? And the first thing we wanted to look at is what's the current situation with our give or take 30,000 employees? Well, I think most everyone in this room has a good idea. Our employees, like millions of other employees, are forced to access care during work hours. Employees unable to seek care during work hours are faced with seeking care either after hours in urgent care, in emergency care settings, or they just choose not to access care at all. Looking at some of the data, the Commonwealth Health Fund Quality Survey, a random nationally representative sample of adults at least 18 years and older in the continental United States completed via phone interview, found that four-fifths of adults surveyed in 2006 had a regular care or primary care doctor. Moreover, among those with a regular source of care, 85% found it was not difficult to contact them via telephone, 65% found it not difficult to get care or medical advice after hours, and 66% found that their doctor's office visits were, or felt that their doctor's office visits were well-run, organized, and running on time. All rosy. However, only 27% met all four criteria, driving them to seek care in costly alternative environments, not seek care at all, or just take maybe a vacation day from work. And one can see how this scenario results in escalating healthcare costs and consumer dissatisfaction. So why do our employees choose to access the emergency care department? Koster and his colleagues completed a rapid systematic literature review, putting together their published research from urgent and emergency care settings to identify the drivers for patients' decisions and why they access urgent care for non-urgent needs. They identified six general themes, or six factor categories. First, confidence in primary care and access to care appointments, which encompasses service-defined barriers to care. In most studies, patients had access to a primary healthcare and instead chose to seek more urgent care or emergency care, often without contacting their PCP first. An overall lack of confidence in their PCP's abilities was found to be a recurrent theme. Several studies attributed dissatisfaction or a negative prior experience with their provider with up to 10% of all of these visits. There were multiple reasons why people felt accessing primary care healthcare was difficult, anticipated wait times, a general feeling that their PCP was too busy, as well as a general lack of awareness of other services were all found to be factors. Moreover, there was evidence that different population groups had different views and used services differently for different reasons. For example, older people tended to be distrustful of telephone services and preferred to see a familiar PCP rather than access out of our services, whereas younger people conversely chose emergency and urgent care services over general practitioners. Regarding urgency and anxiety, this theme is based on patient-based anxieties rather than actual desire for specific medical interventions. Patient anxiety was strongly related to healthcare-seeking behavior, and this linked closely with the reassurance that patients obtained from emergency services and the emergency department. This is, of course, juxtaposed by the finding that patients are not always capable of assessing which healthcare problems required emergency care services and were sometimes unsure of the legitimacy of their problems, not a big surprise. The views of family, friends, and healthcare providers was found to be an important contributory factor in patients utilizing ED services. Up to half of all patients that attended the ED for non-urgent reasons did so on advice from their primary care doctor, advice from their friends, or advice from their family. Convenience. This theme describes patient-specific issues centered around how they view the convenience and access to the emergency room. The perceived convenience of emergency and urgent care services was a key driver in their decision-making, and this is also linked to negative views and inconvenient views around primary care access. Access to primary care is often viewed as limited due to more structured opening hours and perceptions around difficulty obtaining appointments. And there is a view that the ED is more convenient due to factors such as 24-hour availability and not having to make an appointment. Individual patient factors. This essentially boils down to cost and transport affecting decision-making. For example, not having a car prompted some service members to use ED, ambulance, or urgent care services. And we can see this is a big issue in Greenwich where everyone kind of commutes into our hospital. And finally, perceived needs. These are just the patients that feel they're just too sick to be seen by a primary care doctor. Specifically, this stems from the belief that their condition needs hospital-required diagnostics, particularly radiography. How effective are worksite clinics? So we've kind of looked to see why people go to the ER. How effective are worksite clinics? Shelley et al. completed a systematic literature review exploring evidence regarding worksite primary care clinics, including current rationale, historical trends, prevalence and projected growth, expected health and financial benefits, challenges, and future research. Significant themes identified were increased access to care, increased patient satisfaction, and a cost reduction in services when compared to offsite health services. When comparing an onsite health center versus a community health center, each visit yields an additional three hours of productive work time, eliminating travel time, work release, and wait time to see provider. And when extrapolated to the United States as a whole, it represents about a 10 to 30 percent total savings. McCatskill et al. completed a cost-benefit analysis on the effectiveness of an on-site health clinic at a self-insured corporation, similarly to Yale. Study design being a retrospective chart review of full-time insured employees treated for upper respiratory tract infections, or URI, over a one-year period. On-site clinic costs of treatment URIs were compared to costs at an outside community providers for similar care. And we'll go over the data in a second, but what the results showed is that the university's on-site healthcare service were determined to be more cost-effective than similar services provided by outside clinics. The clinic did identify a need for efforts to maintain sustainability, such as newsletters, staff meetings, informational flyers, in order to keep a high rate of utilization. And here we can kind of see the raw data for the study. The table reveals the financial cost differences between the on-site health clinic services and the off-site services. Based on the data provided, the university saved about $23,000 during the first year of the study, and we can see why if we compare the cost per on-site clinic screening between the two locations. This big difference was attributed to the fees and costs associated with the delivery of healthcare and services in the community or private sector. And one thing to note, similar to our model, expenses for space, utilities, and durable equipment were not included as the employer already had an existing student health clinic. So just keep that in mind when looking at this data. In summary, the relatively new implementation of worksite clinics means that there's nominal evidence regarding cost-effectiveness, utilization, and prevalence. The majority of literature is confined to our journal, the Journal of Occupational Environmental Medicine, and there does exist anecdotal evidence that worksite clinics positively impact productivity, absenteeism, presenteeism, disability, and direct costs. And of course, further research is needed to see how worksite clinics impact cost. So we've talked some about the utility and why people choose to access the ED or current care. What does the current landscape look like among similar employers, CEL, New Haven Health? What are our competitors doing? The annual Mercer Worksite Health Center survey surveyed 142 employers with on-site or near on-site clinics that provide care to employees. And as we can see, clinics are mostly offered by large employers. Since 2010, the prevalence of primary care clinics has risen from 20 to 31 percent of U.S. employers with more than 5,000 or more employees. In some cases, existing occupational health clinics have been expanded to provide non-occupational services as well. However, during the same 11-year period, the proportion of employers of this size providing occupational health services through an on-site or near-site clinic declined from 35 to 25 percent. The overall decline in manufacturing in the U.S. and reduced injury rates may be factors, and some employers, which we'll talk about in a little bit, may be taking advantage of options to outsource occupational health care to local health care providers. Prevalence. What is the prevalence of worksite clinics by industry? Maybe not surprisingly, health care systems are the most likely to offer worksite clinics. Sorry about that. 54 percent are offering occupational health services, and 49 offering non-occupational primary care services. For hospitals and other health care facilities that are undergoing surveillance and screening requirements, worksite clinics are typically easier to set up and operate as they exist within a health care environment and you can utilize existing space. As well, and kind of similar to some of our clinics, they may serve outside organizations as well as the facility's own employees, helping to subsidize some of the costs of the clinic. Among manufacturers with 5,000 or more employees, 31 percent offer a clinic for primary care and services. Manufacturers tend to have large workforces in a single location, and if we remember historically have offered occupational health services to assist employees with injuries and exposures. Many have expanded these clinics to provide primary care services, leveraging existing infrastructure to engage members and advance their health promotion objectives. And only a small portion of the 142 clinics surveyed offered just occupational services, 4 percent, while a combination offered occupational and primary care services, 38 percent. The majority just offered primary care services, 58 percent. What type of clinic was offered and who do they serve? The majority of sponsors operate at least one on-site clinic. Virtual clinics are offered by 10 percent of sponsors and are mostly often staffed by a registered nurse, medical assistant, or an LPN. However, interestingly enough, about a fifth of all are not staffed and only consist of a monitor and or diagnostic equipment. Four percent of those surveys offer a mobile clinic, mobile clinics consisting of a doctor's office, exam room located inside a van or RV. Generally, these deliver care to populations that don't have access to on-site or near-site clinics. And if we kind of move to the right side or your right side of this slide, just over a third of survey respondents contract with at least one shared multi-employer clinic at their biggest location. Smaller employees are most likely to use a shared clinic and among clinic sponsors with fewer than 5,000 employees, 47 percent offer a shared clinic compared to just 7 percent of employers with 5,000 or more employees. Although 14 percent of these larger clinics are open to sharing with a nearby employer, so they're open for business. Furthermore, an employer that offers an on-site clinic at its largest location might choose to contract a shared clinic to provide a similar benefit to employees working at a smaller location. And these arrangements are becoming more and more common as the vendor marketplace expands with solutions designed around smaller populations. What model and what model were we thinking of using when designing our easy care model? The most respondents were most likely to report that their clinics were staffed by nurse practitioners, 75 percent, followed by medical assistants, 68 percent, and physicians, 65 percent. Half of all respondents had a nurse on staff and over one-fourth had a physician's assistant. Specialty practitioners are relatively rare with physical therapists on staff just 18 percent of the time, and pharmacists and pharmacy techs only on staff about 11 percent of the time. Employers seeking to leverage their worksite clinics for their employee wellness programs have added health coaches, which you can see in 30 percent of respondents, or wellness coordinators, 14 percent, and nearly one-fifth have a registered dietician or nurse, or nutritionist, rather. And a few even have an exercise physiologist and an athletic trainer. Some clinics include therapists specializing in complementary medicine, such as chiropractors, massage therapists, or acupuncturists, around 5 percent. And others have added staff to address mental and emotional well-being, such as licensed clinical social workers, psychologists, psychiatrists, about 10 percent. What barriers did we expect to see when we present this to leadership? What barriers can you expect when you're presenting a worksite program to your leadership? The 2017 Workplace Health in America Survey, a nationally representative survey of U.S. employers describing the current state of U.S. workplace health promotion and protection programs and practices in worksites, asked employers about a potential set of barriers. And what they found, again, probably not too surprising to most of us, was that cost was rated as challenging or extremely challenging by the largest percentage of worksites, followed by competing business demands, lack of employee interest, lack of experienced staff, and lack of physical space, followed by demonstrating program results. Interestingly enough, the percentage of worksites that rated cost and competing business demands as challenging did not vary based on workplace size. However, just 20 percent of worksites rated a lack of, just 20 percent of the largest employers rated a lack of experienced staff as an issue, while smaller employers listed about 40 percent were concerned that their staff did not have the proper experience to complete such a program. Thank you very much. I am back. So, to revisit, after that great review of sort of the bigger picture of evidence to support why we have implemented an onsite health clinic, I just wanted to share the listing of the conditions and preventative care services that we do offer to employees so they can feel comfortable to come down if what they're experiencing falls into these categories. So, a lot of earaches and UTIs and rashes and nausea. We do have a couple of more primary care-based items on here as well, hypertension and some high cholesterol, where we're serving as that bridge to primary care. So, the intention is not to treat that on an ongoing basis, but to get them going, get them sort of initially assessed, but then help make them, create those care connections to a primary care or another specialist to provide that ongoing care. We do sort of have it separated between those that we're willing to accept with and without a negative COVID test, just to further protect the employees working in the clinic, as well as the employees that are seeking care there. We do make it very clear that easy care is not intended for emergency situations. If you are supposed to be at the ED, we want you to go there and they'll guide you there if that's where you're intended to be. But for non-emergent conditions, these are what we're offering at this time. So, we went live with easy care June 14th, 2022. So, I have here on this graph, sort of a month over month view of the visits that have come through the clinic. So, we started off slowly a little bit over the summertime, but we've sort of settled around about 30 to 35 sick visits over the course of a month, doing a total of 270 visits through the end of February when I was compiling this data. And we've done just over 20 vaccinations. So, that's been a much smaller piece of what we've done so far. We do anticipate doing some campaigns around shingles and pneumococcal vaccinations and opening up additional slots in the future that will hopefully improve those numbers as well. The graph below is our appointment utilization. So, we're sort of averaging around 36% utilization of our open sick visit slots and that 12% of our vaccine slots. So, as I alluded to earlier, we weren't sure if we were going to be at max capacity all the time or nobody was going to come in, but I think this data is showing us that we sort of have a nice flow. There are some days where every slot is taken and others where there's only one, but we have found that the schedule that we have created and the amount of appointments that we've offered has been working well so far. But we are going to be digging into the data a little bit deeper to see if there's more utilization on certain days of the week, certain times of the appointment slots. We have them vary throughout the day, but we'll use that data to guide us in switching up the schedule to accommodate patients' needs as we move forward. The pie chart that you see on the left is our top treated conditions. So, we have seen a lot of respiratory issues walk in the door, musculoskeletal, ENT, which is a lot of ear aches, earwax removals, UTIs, derm with rashes and things of that nature, injury contusions, gastro issues, a little bit of that hypertension, which is helping folks bridge to primary care or to another specialist, cellulitis. And then, RA purency is a lot of interesting cases walk in the door. So, it keeps her day really varied from the occupational medicine work and then getting to also sort of flex her muscles and treating patients with all sorts of different conditions. The graph on the right is our care connection referrals. As I spoke to earlier, we're taking this as an opportunity to, when it's appropriate, make those connections to the other resources within the organization. So, if somebody does not have a primary care or they need a specialist, referring them over to our patient resource coordinators to help navigate that piece for them, employee family resources, and then our living well cares, our care coordination health coaching team as well. So, always looking for more opportunities to continually to connect our employees with these important benefits and resources that they have available to them. We have a really nice patient story that our RA parent shared with us that I think really resonates and speaks to the power of having this onsite health clinic and sort of the magnitude and the impact that it can have on somebody's care and their life. So, a 50-year-old woman who worked in patient financial services, she presented to EZ Care with a sore throat and ear pain. A few days prior to her EZ Care visit, she did end up and go seek care in the emergency department, but she did not have a resolution to her issues. Her manager luckily educated her about EZ Care and referred her down. So, the APRN saw her and saw that she had an ear infection and provided that treatment. I think what's even more powerful is during that visit, the patient really connected with the APRN and felt comfortable enough to become emotional and shared that she had recently lost her mother and that her PCP had also recently retired. So, the APRN treated her immediate medical concern, but she made those care connections. She referred her to our employee family resources, which offers six free therapy visits to help address her grief. She did take her up on that and follow through with that. Then also to our patient resource coordinators who helped her find a primary care provider, who was able to see her sooner and establish regular care again. She had been trying to find somebody on her own and wasn't having success finding somebody who could see her in the timeframe that she wanted. So, we love sharing this story because it really speaks to the all-encompassing intention for this program that while most folks just use it for that quick, treat the immediate issue that I have, it can provide so many more benefits to our employees. So, transitioning a little bit from what the structure of the program is, is how did we get there? What was the project planning and management process and all the lessons learned and opportunities that we experienced along the way? So, involving all the key players was incredibly important. We started with a smaller leadership group that helped set that design and set those parameters that we wanted to move forward and kind of help make a lot of those key decisions. So, that incorporated representation from our occupational medicine team, population health, clinical operations, our living well cares team, as well as additional perspectives from a primary care physician and our employed medical group, Northeast Medical Group, and from our telehealth team as well. So, we had just a lot of really varying perspectives to help us build out the vision that we wanted to put together, and they helped bring a lot of the pieces to fruition. Having a project manager, that's where I came into play. I got pulled in to sort of help organize all those various thoughts and to sort of lead the project forward from the design phase into implementation, and that implementation phase is where a lot of the down and dirty really detail-oriented work needed to happen. We put together quite an extensive implementation work group that, for a period of a few months, met on a weekly basis. It included representation from our Occ Med team, from facilities, operations, finance. IT was a huge component, and the training folks, because of that Epic piece, we needed to build a new Epic department. We needed to train folks on it, because it wasn't something that they used on a regular basis, so having their input was incredibly important, and then marketing and communications folks as well. So, we were able to take it from an idea to standing it up in just a few short months, which was great. As we continued to implement, we were still creating that proposal, putting all the other pieces in place on the business side, and really pushing forward in all of our proposals the benefits that would come out of this. Improved health, increased productivity, increased job satisfaction, increased retention, and that financial impact and savings. That was a selling point to our HR folks as well, who I had mentioned earlier. We were utilizing their budget to help fund this, so putting all those pieces together into a proposal and to make the case for it was incredibly important. Some other lessons learned and opportunities from the project planning process. We had found, since we had spent so much time in that design phase with some leadership folks, we had a missed opportunity to get earlier buy-in from some of the clinical staff and managers who were working in the clinic. We found that it got to the point of like, okay, we're ready, we're ready to go. And it sort of, it could have felt like it was like, okay, you're placing this on me now. I wasn't as part of the process as they should have been. And that was a huge lesson learned for all of us and creating that change management process, bringing them along in that process and having their input is incredibly important. And we will know that going into some, when we continue to expand across the delivery network, knowing who those people are who are going to be working in the clinic, who will be taking on this work will be incredibly important, especially because they're existing there. They're not necessarily being hired into this, knowing that this is going to be part of their workload. Some other key finance, legal go-no items took much, much longer, I think, than any of us had ever anticipated. We knew they would take a long time, but they took a very long time, really working through the nuances of the business plan, setting up the cost center and sort of where that sat in our complex cost center structure at Yale. And then the patient consent form, which was very, very, very important. It spent a lot of time in legal review, really fleshing out the points of the financial responsibilities and making it very clear that while they are not responsible for the cost of the visit itself, if they are referred on for additional lab work or radiology that it would be subject to their insurance. And also making it very clear that they are voluntarily seeking this care, that it will be documented separately from their workplace record. Things will not be shared with their manager. So that went through a lengthy process of legal review. And what we had found as well is that when we had started the process, we had one contact in legal who had transitioned out and somebody new came in. So it was kind of starting that process all over again of explaining how and why we're doing this. Once we did get the approved legal language, there was also a forms committee to go through. So sort of one added layer to have it reviewed by another committee, have it approved, and then ordering the pads to have available. So while we do also have a paper form, we did incorporate it into our e-check-in process as well, which is really handy. Something else we learned along the way is that it's okay to adjust the timeline and scope or create a phased approach. My earlier slides I had mentioned, we intended to offer biometric screening. That was a whole barrier of a process taking CLIA into consideration and all the QA and the training to offer that piece that really sort of we're intending to mirror our employee Know Your Numbers program that we offer. And it was at a point where it was putting the go-live and sort of the rest of the work at risk. So it was one of those conversations we needed to have with our leadership team to put everything out there and say, we're working on this, but it is going to impact our ability to sort of stand the rest of it up and to get people in the door to being seen. So it was one of those items where we just had to say, okay, we need to take this off the table right now and revisit it later and continue to move forward with the other pieces that we knew we could stand up in the timeframe that we needed. And then utilizing subgroups more. We had quite a large implementation work group that met on a weekly basis. And I think instead of having other ad hoc type meetings throughout the week to get the work done in between, utilizing some additional specific subgroups would have helped move the process along as well. So pivoting to sort of that immediate post go-live lessons learned. So that very first week we were lucky enough to have an on-site EPIC support who works in our Northeast Medical Group EPIC optimization team. So we were incredibly lucky to have that person on site for those first few days, that first week, to work alongside the MA and the clinician as patients were coming in to help them with their documentation and understanding the new workflows, because this was a new process for them and getting them comfortable. And a recommendation that came from that EPIC support person was to reduce that OCMED schedule that first week to accommodate the go-live. We had just started up without modifying any of the other schedules. And I think we can agree that first week was a little crazy, but we got through it. But knowing that going forward that we may need to make some modifications as we're able to and appropriate would be really beneficial. Continuing that internal staff communication relationship building. When I had mentioned that those on-site folks really helping to help them communicate as best as possible with some of these added responsibilities and helping them to continue to build that relationship so that they can make everything run really smoothly and so that it would be the best experience for patients walking in the door. We also did some ongoing definition and documentations of roles and workflows. So as we went through the process, if we found something wasn't working quite as we had expected, we talked it through, adjusted the workflows, we created some vizios for some of the different situations and just continually updated those as we needed in those first few weeks. We also found that it was important for us to cross-train the clinician on the MA front desk workflows for backup purposes, because this particular clinic only has the two folks staffing it. If the MA was tied up with something else and wasn't available to check somebody in or to start the visit, the APRN needs to know what those workflows are and to be able to facilitate that in Epic and carry them through the process without a break in flow. We did go through stages of needing stronger COVID screening protocols that people were coming in inappropriately. So making sure that we assessed that beforehand if somebody had scheduled later in the day to maybe give them a call and say, hey, how are you feeling? Like what's really going on? And if we needed to refer them to our COVID call center to be tested, we were able to sort of triage that before they walked in the door. Ongoing marketing communications to keep the service top of mind. We utilized the Greenwich Hospital specific communication channels. So they have an intranet site. They have a very specific employee newsletter. They have an employee wellness committee that we presented to. But I think what's been amazing here from a marketing perspective is the APRN that we have staffing the site has been incredibly passionate about the project. And she's been, I think, one of the best advocates for it. She talks it up all the time. If somebody's in clinic for an occupational medicine purpose she's going to hand you a flyer and say, hey, if you have any other needs down the road, come into easy care and I'll take care of you. She'll visit different floors and departments. She'll talk at team meetings. She attends safety huddles. So having the clinician spread it by word of mouth has been incredibly helpful in building that rapport, building that trust and leads to examples like the patient story that I shared earlier. So in addition to some of the traditional marketing communication channels, having the passionate staff members speak on behalf of the program has been so valuable. And then continuing to optimize that e-check-in process. Depending on timing of when somebody's coming in, if they just scheduled it and walked in the door, they may not have the opportunity to do the e-check-in. But if they are scheduling ahead of time, it smooths out the process a little bit. So they don't have the paper forms they have to sign. We don't have to upload them into Epic. And our organization is improving in e-check-in across the board, across all the different sites. And then the patient satisfaction survey distribution has been an interesting case. We created a survey, but we didn't have, and to be honest, still don't have the best mechanism to get it in front of people to take it. We started with a QR code that we have printed out on a little piece of paper to hand them as they leave or up in the exam room, but we're just not finding people or taking that step to do it. It's just one more part of the workflow that we're finding doesn't always happen. So we do continue to explore different ways within MyChart to try to automate sending out the survey or utilizing a service called RX Health, which would be intended to text out the survey. So that's been an interesting case of trying to figure out how to get that important feedback, because we have a lot of anecdotal feedback, but trying to quantify it in that survey form and really collecting those thoughtful responses will help us to continue to grow and evolve and sort of sell the program as we want to grow it. And then sort of in that six-month post-go-live, like where are we with continuing to look at those optimization opportunities? So continuing that staff cross-covered training and support. We find when somebody is out and you're needing to bring in somebody per DM, they need to be able to pick up that work and do that check-in or be that clinician who can do the easy care visit. Appointment flexibility for more access during our open hours, so sort of playing around with offering different times of day. I talk to the patient satisfaction surveys, ongoing marketing and promotion, focusing more on supply tracking and management to make sure that we're allocating expenses as closely as possible to our cost center. And then just opportunities to continue to work with our AHRQ Health nurse line to align and triage appropriately to easy care or video care on demand. And we're also going to want to plug into our nurse triage that we're building out as well. So if an employee calls in, here are my symptoms. If they are at the Greenwich location and it's appropriate for them, those folks could schedule them in for an appointment. Looking ahead, I will say, I wish this was in a few weeks. We are getting our data, our claims data in next week to begin looking at if we have made an impact on reducing avoidable ED utilization. So I'm sorry that unfortunately we're not able to share that level of detail today, but that is our next step, is looking at all of that ED data, looking at Greenwich specifically, but also looking at the trends of all the other delivery networks to see if they're still trending up, Greenwich is trending down. That's the story we're hoping that the data tells us, but also tracking to our business plan so that we can begin to put together a plan for expansion. A few years ago, we had designated Bridgeport as our next location, but all locations are on the table, Bridgeport, New Haven, Lawrence Memorial, Westerly, to find what the next best fit is that can accommodate adding this additional service into their workflows. I mentioned the biometric screening, so that's also continues to be on our roadmap to pilot that and begin offering that as well. And then some additional service offerings that we hadn't anticipated, but folks have come in for to be like, hey, I need a Tdap vaccine, I'm going to be a new grandparent and I need to have that done and it's just a nice convenient time to get it done, or a brief work or school physical, I'm going to start taking classes or I'm going to start a per diem job, like can I come in and have this done? So taking a look at some of that feedback and continuing to improve what we're able to offer. So with that, I just have a couple of slides of just some of the marketing materials that we have put together. We have on our intranet, a SharePoint site that houses all the information about easy care, the hours, the location, all of the different conditions that we will treat, frequently asked questions, that really walks through all the nuances of the program. It will link them over to self-schedule an appointment or link them over to some of our other programs and benefits like Living Well Cares, our patient resource coordinator, so that it's all housed in one spot. And then we have our flyer that we've created and have spread throughout the organization or at least down in Greenwich, that again, high level lists what the program is, what they can come in for, location, and we have a nice little QR code on there. And then we had a really nice article posted in their on-call newsletter. There's Patty, she is the APRN that I have talked so highly about, who has really spoken so well about the program to everybody. We're lucky to have her. And so with that, that is our presentation. Thank you so much for your time. I think we have enough time for questions. So happy to take those. Thank you. Thank you. Thank you. Thank you. Thank you. Questions, comments, if you could come to the microphone and the speakers, I'm sure can answer them. Hey, good morning. Thanks a lot. My name is Dave O'Brien. I have two related questions. The first one is incentives for the Occupational Health Clinic to take on additional work, whether it's a professional satisfaction, financial, job guarantees. And in a related question, for the employees who choose to be seen there, are they actually being paid during the time that they're there, or do they actually check out for more time? Thank you very much. No, those are great questions. So at this time, there's no additional incentive pay or bonuses associated with the additional workload. We did find at the Greenwich location that there was capacity there. So it filled some of that additional time that may have been downtime. So it was an additional benefit there. So at this time, no, I'm not sure if anything is coming down the pike for that. I think the biggest thing is the capacity. We have the capacity at Greenwich, and we have similar capacity at Bridgeport, too, with two clinicians covering there. I can add that the clinicians in the system are incentivized through a bonus program, physicians and APRNs. And measures of productivity are important as one of our operational goals, and it's reported on. So I think indirectly, at least, you wanna get your schedule filled. I will say, though, that because there was a vacancy within the time periods we were creating this, we were able to recruit an APRN who's completely passionate about this kind of work. She is that classically, internally motivated individual. So finding the right individual, I think, is there. Brianna did mention that there was some distress, particularly around the implementation of two electronic medical records. And I think to incentivize the individuals is probably in planning to include them so that proverbial with and what's in it for me and get people excited about it. So incentivization, was it necessary? Involvement and participation up front, perhaps. But again, finding the right provider. Now, in future recruitments of clinicians, I'm no longer with the system, but as a part of the group, we are recruiting with job descriptions that include. So the job descriptions be updated. So as we get a new clinician in particular coming into one of the clinics, which is slotted to be having easy care come on site, it's important to recruit into that position an individual that wants to balance traditional occupational health care as well as primary care. You know, there's often a lack of individuals who have both, so at least somebody to learn and grow into that role under tutelage of something like Dr. Pastana to help guide them. And people do get excited about it. There was a second. Yeah, the second question. We had talked about whether or not we were gonna force people to clock out, but quite honestly, reducing sort of like the nitpicking of clock out for the 20 minutes. The managers were just really on board with saying, okay, go down, get taken care of, come back, as long as you arrange for coverage, if you need coverage, however that was appropriate. But we haven't found there to be any issues with needing folks to sort of get down to that nitpicky level of clocking and clocking out. Yes. Yeah. Thanks for the talk. Just a quick question on the benefits side. Did anyone from your benefits, HR folks, did anyone raise the concern of, since there is no out-of-pocket cost, did anyone raise the concern of that possibly creating a taxable benefit for the employees? That's a good question. I don't recall that coming up, but a good takeaway to revisit. Good takeaway to revisit. Thank you for that. That's what I think is the best concern. Okay. I mean, I don't know. Yeah, no. Perhaps if we asked the question, we'd still be in the business. Yeah, yeah. We do know that under health plans, somebody who's under HSA, for example, after a certain number of visits, there would have to be an out-of-pocket cost. We're self-funded, et cetera, so I presume that that may have been contemplated in the background, but up front, perceivably not a barrier. Yeah, we have some different- That's a very good question. It is. We have some different folks on our benefits team now from when we originally did this. We had a new director of HR benefits who has very extensive background, so that will be a great question. I'm sure she will ask it, so I'll take that away to be prepared if that does come up. Thank you. Yeah, and I will say that how I would address it would be we want to do this, we want to be sure, we want to understand how we can provide that service within the benefit, the art of asking how we do it best versus can we do it. Yeah, I agree. Thank you. All right, with that- All right, well, I want to thank Brianna. Exceptional project planning and maintaining and really-

on-site health clinic

Easy Care

Yale-New Haven Health System

access to healthcare

reduce emergency department utilization

employee health and well-being

implementation process

patient satisfaction

data analysis

expansion planning