By Anthony Vecchione
Improving Access And Quality Is Key To Growth
There has been a surge in the number of on-site health clinics over the past several years and it comes as no surprise to industry observers.
According to the results of a 2012 survey by Mercer entitled “Employer-Sponsored Worksite Health: Offering Solutions Across The Globe,” site-based health centers and local health resources are becoming a “critical part of many employers’ future health and wellness strategies.” In addition, employer-sponsored on-site health is increasingly being viewed as an appealing solution to the challenges of access, affordability and non-compliance.
The increasing demand for on-site health facilities is being fueled by:
- A greater employer awareness that properly managed clinics can save money and improve population health
- An increased willingness by employees (and dependents, when eligible) to voluntarily use worksite health centers for non-occupational health needs
- The perception by many that healthcare reform may compromise access to care as millions of uninsured Americans receive coverage with improved access, straining finite health delivery resources
According to Mercer, this surge of interest is not just in the traditional clinic/health center approach. “Employers are experimenting with new models for reaching their employees in smaller and more remote locations, focusing on the chronically sick/highest-risk members and positioning clinics as on-site hubs or ‘ambassadors’ to a company’s full range of health and wellness related offerings,” the report states.
Data from the Mercer study revealed that many employers are leveraging these clinics in innovative ways. The study reported that site-based health centers and local health resources are becoming a critical part of many employers’ health and wellness strategies.
“I believe many employers are turning to on-site medical clinics to save costs by decreasing the amount of time employees are out attending to medical visits, decreasing the utilization of emergency departments for non-emergent illnesses and by promoting them as a benefit for employees by decreasing or eliminating the deductible/co-pay requirements if seen on-site,” said Kim Eidson, health services manager at Cargill Meat Solutions in Hazelton, Pennsylvania.
Denise Dumont-Bernier, director of workplace health at the Maine General Medical Center in Augusta, Maine, said that years ago only employers with 1,000 employees or more with higher incidences of work-related injuries considered adding an on-site clinic. “Avoiding lost productivity when employees needed to travel to off-site medical clinics was a driving force [in a company’s decision] to keep medical services at the work site, and typically the larger, often self-insured employer was in the best position to afford these services,” said Ms. Dumont-Bernier.
Ms. Dumont-Bernier said that in rural areas of Maine, observers are noticing employers with fewer than 150 employees choosing to bring medical, nursing and wellness services to the work site, sometimes for only four hours a week but with tangible benefits. “Sometimes geography plays into the decision, i.e. the work site is over a half-hour hour drive [from] the nearest medical facility and time away from work and lost productivity are substantial in order to obtain medical care.”
Sometimes, Ms. Dumont-Bernier said, a high-quality occupational medical provider is not available near the work site so contracting to bring one on-site is better than using local providers.
Trends
Donna Lee Gardner, R.N., M.B.A., senior principal at Ryan Associates, has also observed the growth of on-site clinics. “One is the employer base where we are seeing large employers say ‘I can’t afford to have my employees go off campus and wait in a clinic for care. I need it here.’”
Ms. Gardner noted that many employers with over 200 employees on-site are now actively pursuing on-site clinics. “On the other hand, we are seeing many vendors in the market; currently Walgreens is the biggest vendor, their on-site Take Care program operates more than 400 workplace centers nationally.”
According to Ms. Gardner, Walgreens has embarked on a campaign to place more of its clinics in businesses across the county. They go to see the employer, sometimes very large ones, and say “We can come in and do it all for you, electronic medical records (EMR) nurse practitioners, and medical directors.” Peter Vasquez, M.D., national medical director at Take Care Health Systems, told VISIONS there is growing interest among a wide variety of employer groups for on-site health and for the ability to provide access to an expanded scope of services.
“Years ago, the focus was on occupational health and acute care. We are now seeing employers looking for chronic condition management, on-site wellness coaching, primary care, and after-hours and telehealth solutions,” said Dr. Vasquez. “Employers are asking [us] to integrate a wide range of capabilities, all trending to improve access of employees and families to patient-oriented comprehensive care,” Dr. Vasquez said. “All of us who provide health and wellness at the work site are becoming more flexible in our offerings as well as in the ways we deliver [them].”
Dr. Vasquez pointed out that this evolution is creating new partnerships across on-site vendor partners, specialty service providers, benefits plans, regional health systems, and consultants. “Each is called on to not only execute their particular contracted services but also to serve as a subject-matter expert in their areas of expertise and to work together to provide an integrated health and wellness solution,” he added.
“The most exciting movement in the work site space is the development of Patient-Centered Medical Homes (PCMH) to provide team-based, patient-centric care for employees and their families,” said Dr. Vasquez. By leveraging the attributes of the PCMH model, quality of care, patient outcomes, and patient experience are enhanced. He contended that further integrating the work site PCMH into an integrated medical neighborhood would further extend the patient-centric experience and help improve care coordination and the use of best practices.
Health Systems Benefiting
Green Bay, Wisconsin-based Bellin Health first noticed a surge in on-site medical clinics in the manufacturing sector, then in municipal governments and school districts. “The reason we’re seeing that is because we’re starting to see results around these on-site clinics,” said Randy Van Straten, vice president of business health and executive director of Bellin Health.
“We know that typically in a market, 30 to 40% of individuals do not have a primary care [doctor] and typically we see very, very high non-compliance [rates] with chronic disease management and also in prevention.
These are strategies to actually control the rising risk to individuals and those with unidentified conditions,” Mr. Van Straten said.
What On-Site Clinics Need To Excel
Cargill’s Ms. Eidson believes that companies need to be empathetic to the physical and cultural needs of their employee population for on-site clinics to succeed. For example, if the employee population is predominantly Hispanic, having a bilingual physician or providing a technician or support staff to interpret for the physician should be a priority.
“Employers also need to ensure they communicate with employees that all visits to a personal on-site physician are confidential and [personal health information] will not be released to the company for any reason,” said Eidson. In addition, finding a physician is comfortable with the general demographics of your employee base is also helpful.
For occupational health clinics, Ms. Eidson said the key to a great relationship is developing a clear understanding with physicians on issues such as conservative vs. aggressive care, treatment guidelines for referrals and communication with the injured employee regarding treatment plans, restricted duty assignments and any company, local, or state laws the employee needs to be aware of.
In terms of tips for on-site clinic owners and managers, Ms. Eidson suggests:
- Ensure a good relationship between providers and employees
- Establish a good contract with the provider of medical care, with well-defined roles and guidelines, and have it reviewed by your legal department prior to implementation
Ms. Dumont-Bernier said on-site medical providers need to demonstrate value to their client companies. Because economic challenges exist for most businesses, value takes a variety of forms, according to Ms. Dumont-Bernier. “A vendor needs to be able to track encounters and services provided at the work site in detail and aggregate data in a way that shows value for the investment being made.”
She pointed out that this tracking can be financial in nature, showing the lost productivity time saved because services were provided at the work site or the difference between a fee-for-service medical visit and an on-site contracted rate. It can be based on quality and outcome measures, or feedback from the employees who use the services. But a combination of measures is best.
Ms. Dumont-Bernier noted that on-site providers need to be great at building relationships and not shy about interacting with employees while they work, giving ergonomic advice, for example, identifying opportunities to work smarter, making improvements in the environment or set-up of workstations.
Exceptional customer service and close management oversight of the on-site provider is essential, Ms. Dumont-Bernier said. “The employer should realize that the on-site personnel is the bridge to a team of resources and experts coming from the medical practice that are part of a valued business partnership”
Ms. Dumont-Bernier said having medical providers at the work site changes the health and safety culture of an organization. “Seeing the presence of a physician, nurse, physical therapist or wellness health coach at the work site on a routine basis makes employees think about their own health choices and safety practices more often.” Ms. Gardner said on-site medical clinics must develop a model. “They have to have something on paper. That’s what the vendors have. They have a product and it’s clearly defined and identifies what they do, what the employer needs to do, what the return on investment (ROI) is and what is included in their product.”
Mr. Van Straten said on-site clinics should deliver three things:
- chronic disease management
- prevention via physical exams and screenings
- acute care services
“The key is with the acute care services,” Mr. Van Straten said. “While people are in for acute care, we need to also ask them about prevention and make sure they are compliant with their prevention plan and any chronic conditions they have.” Walgreen’s Dr. Vasquez said that first and foremost, on-site medical clinic staff should listen. “It is important to fully understand the vision of the employer, as well as their specific needs.” He pointed out that each employer has a specific set of health-related challenges within their unique culture.
“To serve as true partners,” Dr. Vasquez said, “we start with the employer’s vision and goals, then make recommendations based on the breadth of our experience working with employers of all sizes in all industries and provide recommendations regarding the best services and processes to assist their employees and the company in their wellness journey.”
