Toyota Ernie Richardson

Toyota Integrated Medical Management

Presentation Overview • Toyota Safety Overview • Toyota Kentucky (TMMK) clinic Kaizen • Toyota Texas (TMMTX) integrated medical

Toyota Motor Engineering & Manufacturing North America, Inc. Vancouver, Canada

Cambridge, Canada

Freemont, CA

Princeton, IN Buffalo, WV

Erlanger, KY

Long Beach, CA

St. Louis, Troy, MO and Jackson, TN Georgetown, KY

Baja CA, Mexico

Employment: 38, 340 Capacity : almost 2 million vehicles Investment: $16.8 billion Toyota clinics

Huntsville, AL San Antonio, TX

Toyota Safety House Team Member’s Individual Responsibility

Injury & Illness Prevention

Early Intervention (ESI)

Care Management Activities

Business Planning Process Review Safety Auditing

Management Commitment Design Budget

Leadership

Kaizen Training

TPS

VALUES

HOSHIN

Toyota Safety House Team Member’s Individual Responsibility Early Symptom Intervention Injury & Illness Prevention (ESI) •Equipment Design

•Early Symptom Investigation

•Process Design

•Investigation

•Vehicle Structure Design

•Countermeasure Plan

Care Management

•State of the art clinics, evaluation centers, and diagnostic tools •Care Managers •Modified Duty

•T/M Education & Training

•Re-hab Consultants

•Posture Confirmation

•Low-level Treatment

•Repeat Injury Focus

•Focus on Top 10 Risk Processes

•G/L Modified Duty

•Workforce Review Meetings

•STOP 6 hazard identification •Concern Registration Systems

•Follow-up

•Restricted T/M Utilization

•Complex Case Meetings •Indefinite Restrictions •Medical leave of absence •Job Placement •Work condition/work hardening •Reintroduction

Toyota’s Health/ Wellness Vision: Integration, Occupational Health & Benefit Old Vision Occupational Health

Personal Health *Benefits Group

*Safety/Medical Group

New Vision Total Health/Wellness Care *Health/Wellness Group

Toyota Motor Manufacturing Kentucky Georgetown, KY

Toyota in Kentucky Toyota Motor Manufacturing, Kentucky, Inc. •Established 1986 •Production Start-up 1988 •Employment: Over 7,000 people •Size: 7.5 Million sq. ft. under roof •172 acres / equivalent to 156 football fields

TMMK

Toyota Motor Manufacturing KY • Toyota largest manufacturing facility outside of Japan • Annual capacity 500,000 vehicles

Vehicles Built at TMMK

Solara

Convertible Solara

Camry

Avalon

Toyota Kentucky Clinics • 2000 clinic-Occ health • 601clinic-Wellness clinic • 800 clinic-Occ health

601 Clinic/Wellness Kaizen Activity • Wellness physicals • Hearing test • New hire physicals

Applying TPS to an Occupational Health Center: Strategy Overview • CHD Meridian onsite management participated in a 5 day training activity focused on Type III Standardized Work Assessment • Participants were assigned a specific staff member to study • Kaizen and counter-measures were implemented as a team • Results were presented to Toyota & CHD Meridian management

Improving the Process: Kaizen Activity • Standardize – Detailed process and script for each element of the required physical – Work Station • 5S (clean, sort, etc.) • Use Visual Controls – Label for supply location – Key Points for Work Process

• Eliminate non-value added work • Decrease Walk Time

Standardization of Work & Eliminating Waste: Activity Goals • Learn how to make standardized work in off-line jobs • Grasp current clinic situation • Identify areas for standardization improvement • Eliminate muda (waste) and free up resources to provide new services • Target 450-minute reduction across all processes

The TPS Process • Training on tools and methods • Evaluate Initial Condition (Time Studies and Observation) • Analyze Data – Identify Muda (Waste) • Wait time • Fluctuation

• Kaizen processes • Develop and implement Standardized Work

Analyzing the Data Before Y am azum i 650 600 570

550 500

30 90

20

185 450

450 400

50 20

50 90 10

70

350

90

40

10

10

F luc tuation W ait

300

566

W ork

250 200

6

4

489

440

398 322

150

429 364

364

397

100 50 0 Phy . A s s is t.

Phy s ic al #1

Front Window Front Window Phy s ic al #2 (1sPhy t s ic al #2 (2nd Drug Tec h. 2s t s hif t 1s t s hif t s hif t) s hif t)

A dminis trativ e A s s is t.

Superv is or

Kaizen Results • Exceeded Target Reduction (450 minutes) – Overall reduction of 533 minutes of process time

• 41% increase in overall clinic capacity • 45 minute average reduction of Mandatory Physical Exam process time • 56 minute average reduction of Wellness Physical Exam process time

Kaizen Results: Reduction of Waste & Variance A fte r Y a m a z u m i

W o rk W a it F lu c t u a t io n

60

274

266

350

46

As

sis t

ec mi ni s tra tiv e

Dr ug T

Ad

2( l# Ph ys ica

l#

2(

1s t

2n d

sh ift

sh ift)

t 1s ts hif Ph ys ica

Wi nd ow

ds hi f t nt

2n w Wi nd o nt

35 40

60

1 l# ica Fro

345

pe rvi so r

10

375

h

10

ys Ph

ss ist yA

375

424

40 100

30

Ph

566

Su

302

436

Fro

600 500 400 300 200 100 0

Outcome • There was no decrease in staffing. Staff was shifted so increased services could be provided. • Some of the added services was Convenience Care Clinic Optometry Services

Convenience Care Clinic • I.H.S.Clinics are offering treatment for acute personal health conditions. • For example: – – – – –

Colds, flu, sinus infections, pneumonia Minor cuts and burns Eye injuries Lab work (will send to personal medical doctor) Acute episodes of chronic diseases (high blood pressure, diabetics, heart conditions)

• TMMK added this service on 1/23/06. • TMMK’s Clinic provides quality and convenient health care for team members. • Additional service has no impact on other medical benefits.

Convenience Care Clinic Impact 2006 Cummalitive Totals 2007 Cummulative totals

Convenience Care Clinic - 2007

2408

2400

2228

2200 1946

2000

1907

1723

1800

1400

1205

1318

1200

1321

1005

1000

985

800

808

624 634

600 400

1527

1613

1600

375 295

295

339

351

333

March

April

295

294

May

June

Since Inception January 2006

200

4315 Episodic Care Visits

0 January

February

July

August

Sept

Oct

Nov

Dec

8630 Work Hours Saved

Toyota Manufacturing, Texas, Inc. •Established 2004 •Production Start-up 2006 •Employment: Over 2,000 people •Size: 1.5 million square feet •Plant size 2,000 acres •Annual production capacity 200,000 Toyota Motor Mfg, Texas

Toyota Manufacturing, Texas, Inc.

The Toyota Tundra

Toyota Family Medical Center

Toyota Family Medical Center : A Comprehensive Primary Care Facility • Built to Deliver – – – –

Workplace Safety Cost Savings Quality Care Employer of Choice Status

• Services Offered – Primary Care – Occupational health – Rehabilitation/return to work/physical therapy – Optical care – Diagnostic x-ray/ ultrasound/laboratory services – Dental services – Pharmacy – High-performance specialty and hospital network

Toyota Production System • Applying TPS / LEAN processing to a Health Center – Obtaining Efficiencies – Do we take the savings or do more? – Redeploying Resources – Moving beyond Occupational Health – Producing Savings – Health Care Costs & Productivity Savings

• The Toyota Family Health Center in San Antonio – – – –

Occupation Health Comprehensive Primary Care Full Service Pharmacy High Performance Specialty Network & Hospital

Strategy • Impact costs by improving quality • Enhance quality through best practice guidelines and protocols • Improve access by providing convenient, high quality facilities • Gain appropriate access to health care data • Achieve flexibility in benefit design • Focus on wellness and prevention • Data, systems and health care integration (occupational and non-occupational)

Integrated Medical Strategy • Implement a comprehensive health care strategy that contains costs while providing high quality, accessible care by providing on-site primary care.

Lower costs

Care provided for: - Team members

Higher quality care

- On-site Supplier Employees

Measurable outcomes of services

- Eligible Dependents

Healthier Team Members Primary Care Clinic Plan Design

-Family Practice -Internal Medicine -Pediatrics

-Physical Therapy -Rehabilitation

-Dental -Optometry -Lab

-Access to a Fitness Facility

Pharmacy Occupational Medicine

-TPA Function -Radiology

Direct Provider Contracting Integrated Leave Management Prevention and Disease Management

Data

Health Care Flow Current Process

Integrated Model Process

-No utilization steerage -Does not support consumerism -Toyota is missing from process -No control of price increases -Current process leaves room for error

Pediatrics

Pharmacy

Primary Care

On-site Primary Care

Optometrist

Lab tests, MRIs, X-Rays, etc.

Dentist

Specialists

Hospitalization

3rd party claims administrator

In-network Specialists

In-network hospitals 3rd party claims administrator

Direct Provider Contracting Current System

Direct Contracting

Network provider Hospitals and Doctors

Network provider Hospitals and Doctors

Toyota

Toyota

Price: • Toyota does not negotiate price • Toyota does not influence or even see price Quality: • Toyota’s influence on quality is limited

Toyota manages price and quality in a manner consistent with Toyota Way and similar to our relationship with other suppliers

Data Integration Medical, Dental, Vision & Rx Worker’s Compensation

STD/LTD

Enrollment Information

Behavioral Health

Results: Coordination of Benefits - Claims auditing - Benefits simulation - Predictive modeling - IBNR/Reserve Analysis - Vendor management tools - Cost Driver Analysis - I.D. areas for Disease Mgmt.



Reduction in errors

On-site Pharmacy Question: Why have an on-site pharmacy? How do they save money?

•Only One Restriction: “Closed Door” •A Closed Door Pharmacy can only dispense prescriptions to those who are defined as beneficiaries of the client organization(s).

Wellness / Disease Management Programs • Wellness • Gordian Get Healthy • • • • • • • •

• Disease Management • Focused Health Solutions (for adults only)

•

Back and neck pain Heart conditions High blood pressure

Weight Management • Fitness • Cholesterol management Acid Reflux management (for adults and children) • Migraine management • Diabetes Smoking cessation • Asthma Stress management • Bone strength management Clinical depression, anxiety or obsessive-compulsive disorder (with medication)

TMMTX Worker’s Compensation • Developing provider network for worker’s compensation cases. • Treatment available at on-site clinic and Family Health Clinic. • On-site physical therapy services. • On-site worker’s compensation adjusters.

Conclusion

We take what we learn from each start up or current operation and try to make the next one the best!!