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Toyota Integrated Medical Management

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Page 1: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

Toyota Integrated Medical Management

Page 2: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

Presentation Overview

• Toyota Safety Overview

• Toyota Kentucky (TMMK) clinic Kaizen

• Toyota Texas (TMMTX) integrated medical

Page 3: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

Employment: 38, 340Capacity : almost 2 million vehicles

Investment: $16.8 billion

Toyota clinics

San Antonio, TX

Huntsville, AL

Georgetown, KY

Erlanger, KY

Cambridge, Canada

Buffalo, WVPrinceton, IN

Vancouver, Canada

Freemont, CA

Long Beach, CA

Baja CA, Mexico

St. Louis, Troy, MO and Jackson, TN

Toyota Motor Engineering &

Manufacturing North America, Inc.

Page 4: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

TPS VALUES HOSHIN

Design TrainingBudget Leadership Kaizen

Process ReviewBusiness Planning Safety Auditing

Management Commitment

Injury &Illness

Prevention

EarlyIntervention

(ESI)

Care Management

Activities

ToyotaSafety House

Team Member’s Individual Responsibility

Page 5: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

ToyotaSafety House

Team Member’s Individual Responsibility

Care Management

•Equipment Design

•Process Design

•Vehicle Structure Design

•T/M Education & Training

•Posture Confirmation

•Focus on Top 10 Risk Processes

•STOP 6 hazard identification

•Concern Registration Systems

•Early Symptom Investigation

•Investigation

•Countermeasure Plan

•Re-hab Consultants

•Low-level Treatment

•G/L Modified Duty

•Follow-up

•State of the art clinics, evaluation centers, and diagnostic tools

•Care Managers

•Modified Duty

•Restricted T/M Utilization

•Repeat Injury Focus

•Workforce Review Meetings

•Complex Case Meetings

•Indefinite Restrictions

•Medical leave of absence

•Job Placement

•Work condition/work hardening

•Reintroduction

Early Symptom Intervention(ESI)

Injury & Illness Prevention

Page 6: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

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

Old Vision

New Vision

Occupational Health

*Safety/Medical Group

Personal Health

*Benefits Group

Total Health/Wellness

Care

*Health/Wellness Group

Page 7: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

Toyota Motor Manufacturing Kentucky

Georgetown, KY

Page 8: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

Toyota in KentuckyToyota 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

Page 9: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

Toyota Motor Manufacturing KY

• Toyota largest manufacturing facility outside of Japan

• Annual capacity 500,000 vehicles

Page 10: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

Vehicles Built at TMMK

Solara Camry

Convertible Solara Avalon

Page 11: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

Toyota Kentucky Clinics

• 2000 clinic-Occ health

• 601clinic-Wellness clinic

• 800 clinic-Occ health

Page 12: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

601 Clinic/Wellness

Kaizen Activity• Wellness physicals

• Hearing test

• New hire physicals

Page 13: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

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

Page 14: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

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

Page 15: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

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

Page 16: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

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

Page 17: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

Before Yamazumi

440

322

566

398364 364

429397

489

30

185

5090 90

490

70

20

50

40

10 10

6

10

20

0

50

100

150

200

250

300

350

400

450

500

550

600

650

Phy. Assist. Physical #1 Front Window2st shift

Front Window1st shift

Physical #2 (1stshift)

Physical #2 (2ndshift)

Drug Tech. AdministrativeAssist.

Supervisor

Fluctuation

Wait

Work

570

450

Analyzing the Data

Page 18: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

• 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

Page 19: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

Kaizen Results: Reduction of Waste & Variance

After Yamazumi

30100

10 60 60 40 5 6

4035

30 4

436302 566

424 375 375 345274 266

100

100200300400500600

Work

Wait

Fluctuation

Page 20: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

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

Page 21: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

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.

Page 22: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

Convenience Care Clinic ImpactConvenience Care Clinic - 2007

294295333295 339

351375

624

808

1005

1321

1527

1723

1946

2228

295

634

985

1318

1613

1907

2408

1205

0

200

400

600

800

1000

1200

1400

1600

1800

2000

2200

2400

January February March April May June July August Sept Oct Nov Dec

2006 Cummalitive Totals2007 Cummulative totals

Since Inception January 2006

4315 Episodic Care Visits

8630 Work Hours Saved

Page 23: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

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 productioncapacity 200,000

Toyota Motor Mfg, Texas

Page 24: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

Toyota Manufacturing, Texas, Inc.

The Toyota Tundra

Page 25: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

Toyota Family Medical Center

Page 26: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

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

Page 27: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

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

Page 28: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

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)

Page 29: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

Integrated Medical Strategy• Implement a comprehensive health care strategy that contains costs while

providing high quality, accessible care by providing on-site primary care.

Prevention and Disease Management

Primary Care Clinic

Healthier Team Members

Plan Design

Data

Integrated Leave ManagementDirect Provider Contracting

Higher quality care

Measurable outcomes of

services

Lower costs

-Family Practice

-Internal Medicine

-Pediatrics

-Dental

-Optometry

-Lab

-Access to a Fitness Facility

-Physical Therapy

-Rehabilitation

-TPA Function

-Radiology

Pharmacy Occupational Medicine

Care provided for:

- Team members

- On-site Supplier Employees

- Eligible Dependents

Page 30: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

Health Care Flow

Pediatrics Primary CareOptometrist

Dentist

Lab tests, MRIs, X-Rays, etc.

Hospitalization

Specialists

3rd party claims administrator

Pharmacy

-No utilization steerage

-Does not support consumerism

-Toyota is missing from process

-No control of price increases

-Current process leaves room for error

Current Process Integrated Model Process

In-network hospitals

On-site Primary Care

3rd party claims administrator

In-network Specialists

Page 31: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

Direct Provider Contracting

Hospitals andDoctors

Networkprovider

Toyota

Current System

Price:

• Toyota does not negotiate price

• Toyota does not influence or even see price

Quality:

• Toyota’s influence on quality is limited

Hospitals andDoctors

Networkprovider

Toyota

Direct Contracting

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

Page 32: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

Data IntegrationMedical, Dental,

Vision & Rx

STD/LTDWorker’s

Compensation

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.

- Plan performance evaluation

Reduction in errors

Enrollment Information

Behavioral Health

Page 33: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

•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).

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

On-site Pharmacy

Page 34: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

Wellness / Disease Management Wellness / Disease Management ProgramsPrograms

• WellnessWellness• Gordian Get HealthyGordian Get Healthy

• Weight ManagementWeight Management• FitnessFitness• Cholesterol managementCholesterol management• Acid Reflux managementAcid Reflux management• Migraine managementMigraine management• Smoking cessationSmoking cessation• Stress managementStress management• Bone strength Bone strength

managementmanagement

• Disease ManagementDisease Management• Focused Health Focused Health

SolutionsSolutions(for adults only)(for adults only)

• Back and neck painBack and neck pain• Heart conditionsHeart conditions• High blood pressureHigh blood pressure

• (for adults and children)(for adults and children)

• DiabetesDiabetes• AsthmaAsthma• Clinical depression, anxiety Clinical depression, anxiety

or obsessive-compulsive or obsessive-compulsive disorder (with medication)disorder (with medication)

Page 35: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

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.

Page 36: Toyota Integrated Medical Management. Presentation Overview Toyota Safety Overview Toyota Kentucky (TMMK) clinic Kaizen Toyota Texas (TMMTX) integrated

Conclusion

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