By Anthony Vecchione
The prevalence of health clinics operating in the workplace, known as on-site clinics, is soaring, and with good reason.
Under the Patient Protection and Affordable Care Act (PPACA), employer healthcare cost containment strategies have become more important than ever.
According to the results of a recent Wells Fargo Insurance white paper entitled “The role of employer-based on-site clinics: Total population management strategy,” employers are searching for approaches to control spending, increase productivity, and have a healthier and happier workforce. (For more information, go to https://wfis.wellsfargo.com/insights/white- papers/Documents/Employer-based-onsite-clinics.pdf)
According to Wells Fargo’s data, employer-based on-site care has historically offered more traditional occupational services, such as emergency first aid, pre-employment physicals and workplace health and safety programs. The present-day on-site clinic concept is employee-centric and offers integrated, comprehensive services that go beyond the four walls of the traditional healthcare system and the limited occupational service model.
THE VALUE OF ON-SITE CLINICS
The Alliance, a Madison, WI-based not-for-profit, employer-owned healthcare cooperative, reports numerous benefits of an on-site clinic, including:
- Better management of chronic conditions
- Earlier treatment of illnesses or injuries
- Fewer emergency room visits
- Improved productivity due to a healthier workforce
- Reduced absenteeism
- Reinforcement of a “Wellness Culture”
- Improved retention of employees
- Improved ability to recruit new employees
ON-SITE CLINIC GROWTH IS EXPECTED TO CONTINUE
According to a 2014 report by Indiana University Health Business Solutions, the prevalence of on-site health clinics for employers with 5,000 or more employees increased from 32 percent to 37 percent between 2011 and 2014. Data from the report reveals another 15 percent of reporting companies were considering adding an on-site clinic in the next two years.
“While the penetration is not quite as high for companies with 500 to 4,999 employees, the trend is the same: 15 percent currently have workplace clinics and another 11 percent plan to add them in the future. Increasingly, employers are coming together to participate in shared on-site programs. In these instances, two or more employers share an on-site or near-site clinic,” the report states.
Industry insiders report that the growth of on-site health clinics is clear to everyone who is looking. Surveys show that many employers are increasingly accepting that the best way to manage healthcare costs and ensure the optimal health of their employees is to maintain a tight arrangement in their own facility with outside specialists.
Denise Dumont-Bernier, director of the Workplace Health Occupational Medicine department at Maine General Medical Center in Augusta, ME, said employers are looking for ways to reduce employees’ time away from the job and improve access to health services at the workplace.
“Now employers are thinking more broadly and realizing that general healthcare Concerns like chronic disease are all leading to increased costs and absence from work. Employers are broadening the scope of what they want to have on-site,” Ms. Dumont-Bernier said. “For us here in Maine, we have employers who are interested in employee wellness/well-being and we’ve put health coaches at the workplace to help with employee well-being for the past several years.”
WHAT’S TYPICAL?
There’s a saying among occupational health industry insiders: If you’ve seen one on-site health center, you’ve seen one on-site health center. Many industry experts agree that clinic models vary and that they all offer nuances that are customized for a specific employer. “In general, we offer the wide range of on-site healthcare services, and work with each client to customize the delivery of services” said Phoenix-based Cheryl Counts, associate vice president of Premise Health. Ms. Counts explains that some clients want it for employees and dependents, while others will open the health center to contracted workers, as well.
“There are also models where we have what we call coalition partners–– it could be an on-site or near-site clinic that has two or more employers sharing the services,” Ms. Counts said. Dr. Ellen Davis, N.P., North East
Eastern Regional Clinical Advisor for Premise Health in Franklin, TN, said that often what clients think they need isn’t really what they need, or vice versa. “We’re able to customize each health center to the client’s needs,” Dr. Davis said. Premise’s clients range from the transportation and energy sectors to manufacturing and financial.
INNOVATIONS AND VARIATIONS
Regarding the latest innovations and differences among on-site clinics, customization is a growing trend. “Across the board the more our member organizations can refine what they are doing in any manner to suit the unique nuances of the individual company the better,” said NAOHP Executive Director Frank Leone.
One company associated with Maine General’s Occupational Medicine department has a call center of 30 employees housed in New York, while another company operates a small printing facility in Connecticut. Ms. Dumont-Bernier explains that they want to be able to offer the same wellness services to all employees wherever they are located.
“For two companies based in Maine we go to their out-of-state location on an annual or biannual basis to build a relationship, to see people in person and do biometric screenings, cholesterol and A1Cs,” Ms. Dumont-Bernier said. Making a face-to-face personal connection really helps people who want to make lifestyle and behavior changes.
“Our model for wellness is personal health coaching. We’re looking at expanding telemedicine services, to be used in a health-coaching [capacity],” said Ms. Dumont-Bernier. At Premise Health, Dr. Davis said one large client is planning a new health center focusing on lifestyle and holistic medicine.
She noted that because lifestyle medicine addresses the patient as a whole – it’s necessary to be able to offer medical care as well as nutritional care and lifestyle education.
“If someone is making bad food choices and they are diabetic, not only do you educate them on how to make better choices, you help them learn how to modify their behavior,” Dr. Davis said. Premise is also mining EMR data to help identify people at risk. “We are currently engaged with two delivery service providers in the state of Oregon,” said Peter Vasquez, M.D., senior vice president of medical operations for Premise Health.
“We are using both direct secure messaging and the e-health exchange health information pathway. Our on-site health center is functioning as part of their closed network of patient-centered medical homes.” Dr.Vasquez said.
TYPICAL FEES
The majority of on-site clinics are a contracted service, not billed to insurance. There are several models. According to Donna Lee Gardner, R.N., M.S., M.B.A., senior principal with RYAN Associates, the model that initially sold well to employers was a contracted service on a capitated basis, taking into consideration the cost of the NP/PA, administrative over- sight, software, CMA and the specific reports required by the employer.
“They annualized those costs and established reimbursement on a quarterly basis. The benefit to employers is phenomenal,” said Ms. Gardner. She explained that employers’ insurance premiums are predicated on the frequency and severity of usage. For example, if you have an on-site clinic that’s intervening and screening your employees and putting together wellness programs, employees are less likely to use urgent care centers and ERs and you are able to identify diseases early before they require costly hospitalizations.
“I look at how many staff hours I am going to be providing to the company and I look at a cost-plus model. What are my staffing expenses, travel, any software we might be using and providing and management oversight?” said
Ms. Dumont-Bernier. “There are different pricing models. There is a fixed fee – where we are assuming a level of risk – the client is billed a fixed amount and we have to be careful in controlling expenses,” said Ms. Counts.
In addition, Ms. Counts cited cost-plus or “the pass-through of the direct costs for operating the health center.” The plus is the management fee. The other pricing model is a risk-sharing model, where we bill the client a per-member, per-month fee.”
SECRETS OF SUCCESS
What makes some on-site clinic programs thrive and others less successful? Dr. Davis at Premise Health stressed the need to be flexible, meeting the clients where they are and matching their needs to a clinic’s offerings.
“I think that’s a huge point for us. That is one of the reasons we are successful as a corporation. We really do meet the client where they are. We get RFPs from prospective clients and they’re not sure what they want – it turns out that they just want a fitness center or a pharmacy – and we’re able to do that for them. We ask them what they are trying to achieve.”
PITFALLS AND CHALLENGES
At some point every on-site health center will face a bump in the road. What advice do the experts have when faced with difficulties? One suggestion is to ensure there is alignment between the service that’s being provided at the on-site center and the client’s benefit plan design.
“They need to be sure they are incentivizing their employees to utilize the on-site health center versus going to a community provider and that the services being provided from the onsite health center are in alignment with the company’s healthcare strategies and goals,” said Ms. Counts.
There should be a balance between standard procedures, necessary for maintaining appropriate quality and delivery, and customization for the client, said Dr. Vasquez.
Navigating the different client benefit plans and community access realities in an effort to appropriately drive utilization of the health center is another key challenge. “We need to market appropriately within the client culture. We need to work with the client to create appro priate incentives for utilization. And we need to work within the medical community so we are seen as collaborative and not as a business threat,” Dr. Vasquez said.
BRIGHT FUTURE
The consensus in the occupational health community is that on-site medical clinics will continue to grow in popularity and remain a key strategic tool for healthcare delivery moving forward. “I really do see a bump over the next few years as large employers start to realize the benefits of having an on-site clinic,” said Dr. Davis, adding that the money saved in decreased time away from work is “huge.”
“It’s an opportunity to provide a distinctive brand of care,” Dr. Vasquez said. “Our approach is helping people and medicine move from a transactional approach to healthcare to a relational approach by engaging people where they are not only geographically at the workplace, but also where they are in their healthcare journey.”
