There is a growing trend toward the delivery of integrated occupational health, personal health and preventive services at the worksite.
While similarities exist among onsite delivery models, each situation features a unique set of circumstances that require providers to adjust to the needs of the employer, the workforce, and when applicable, dependent family members.
The following onsite clinic models illustrate how customized interventions can be used to improve employee health outcomes and lower employers’ costs. The models were presented at the recent annual Western Occupational Health Conference sponsored by the Western Occupational and Environmental Medical Association.
Cisco Systems Pamela Hymel, M.D., M.P.H., Corporate Medical Director
Cisco Systems, a leading supplier of equipment and network Management for the Internet, operates a full-service Life-Connections Center to support the “mind, body and spirit” of its employees and their dependents. The center leverages advanced technology applications to provide a superior patient experience and efficient service delivery, Dr. Hymel said.
The company’s overall objective is to eliminate redundancies in order to expedite care, improve health outcomes and lower costs.
The model features a broad range of in-person and online services. Webenabled functions include electronic scheduling and self-service check-in with e-signature and co-pay collection; electronic health records; secure messaging and prescription management; and online patient satisfaction measurement tools. “We are very interested in changing the way health care is delivered,” Dr. Hymel said. “It’s all about employee engagement. We have a patient-centered medical home model serving employees and their families with easy access to multiple services in one location.”
The LifeConnections Center, housed in Cisco’s first award-winning “green” building, is part of a comprehensive employee health program known as HealthConnections. The concept is designed in response to Cisco’s specific workforce profile: 67,000 employees, including 20,000 in San Jose, Calif; a 93 percent employee retention rate; average employee age of 40; widespread connectivity to online health management tools; and recognition that most employees are company shareholders. It also reflects the company’s values: “providing the best possible service at the lowest possible cost with the least possible impact on the environment.”
In many cases, LifeConnections’ services are supplied in partnership with outside vendors. These services include:
- Primary adult and pediatric medical care
- Laboratory
- Pharmacy – Prescriptions are sent electronically so patients can pick up their medications as they leave the clinic
- Digital X-ray
- Acupuncture and chiropractic care
- Physical therapy
- Travel immunizations
- Health coaching and condition management
- Employee assistance programs
- Telemedicine
- A state-of-the art fitness center
Cisco’s partners include Alere, Cerner, Cigna, Kaiser Permanente, Human Capital Management Corporation, LabCorp, NCR, OptumHealth, Plus One, RadNet, United Healthcare and Walgreens.
Dr. Hymel said a number of factors are taken into consideration when measuring the value of HealthConnections/LifeConnections to the company, its employees and their family members:
1. Customer service and operational performance measurement parameters include visit by number and type; wait times, no-show and cancellation rates; lab tests and X-rays performed at the clinic.
2. Clinic performance measures include utilization, i.e. percent of employees and dependents using the clinic; number of specialty referrals physician performance/clinical outcomes; health status improvement; use of best practice protocols for CAD, heart failure, diabetes, asthma and depression; and reductions in emergency visit and outpatient diagnostic services. According to 2009 statistics to date this year, the greatest number of patient referrals, by far, have made been to health coaches. Other relatively frequent referrals include physical therapy, employee assistance and condition management.
3. Financial performance parameters, quality assurance and the percentage of patients with one or more health risks who are referred to a health management program also are tracked.
In the coming months, Cisco will be focusing on a number of related initiatives, including health outreach to other Cisco campuses via a “TelePresence” platform and enhanced integration of fitness and health programs. “We will be tracking and evaluating all programs and processing and sharing what we learn,” Dr. Hymel reported.
Intel Corporation: Don Fisher, M.D., M.S. Medical Director
Intel Corporation, an international developer of advanced digital technology products, has implemented best practices for health, wellness and employer-based care. The best-practice model is an extension of the company’s longstanding emphasis on general medical and exposure-related monitoring.
A confidential Health for Life program is a cornerstone of the model. The program features comprehensive biometric testing, health risk assessments (HRA), access to wellness coaches who assist with the development of a personalized health program, and resources such as an electronic healthcare library.
The Health for Life program was developed in response to internal research linking aggregate HRA data with aggregate presenteeism data (employees who are at work but not performing at an optimal level). Deidentified HRA results uploaded to an integrated medical management system revealed a need for general health and wellness screening.
In the first three years of a pilot wellness program, measurable improvements were noted in 25 percent of participants in high- and very-high-risk cohorts. In the fourth and fifth years, improvements were noted in 11 percent of the same population. Performance parameters included weight, hypertension, dyslipidemia and glucose.
Meanwhile, the company tracked generally positive increases in the number of participants complying with medication usage to better control chronic conditions. Medications for the management of emotional health resulted in the most significant improvement, saving $648 to $693 per employee.
Over the course of the program, across-the-board improvements in employee productivity are attributable, in part, to general culture change with in the company. The company is now exploring ways to more accurately measure the value of service integration, quality and convenience in the context of productivity improvement, Dr. Fisher said. To date, alcohol use has been shown to be the leading risk factor associated with productivity loss. Chronic conditions associated with the largest productivity loss are back complaints, pain and depression.
Meanwhile, in an extension of the Health for Life focus, Intel is further exploring the integration of general medical care, occupational health, travel medicine and case management functions, starting with a pilot clinic project in Arizona. “The hypothesis is that integration, quality and convenience lead to health and productivity improvement, which more than pays for the program,” Dr. Fisher said.
New United Motors and Kaiser Permanente Roman P. Kownacki, M.D., M.P.H., Director, Employer Engagement, Kaiser Permanente, Northern California
Among its many employer outreach activities in Northern California, Kaiser Permanente (KP) operates an onsite clinic at the New United Motors Manufacturing Plant (NUMMI) in Fremont. Launched in 1984 as a pioneering joint venture between General Motors and Toyota Motor Corporation, NUMMI is now in the process of winding down operations.
According to Dr. Kownacki, NUMMI and its employees reap multiple benefits from Kaiser Permanente’s onsite program, which relies on a sophisticated information technology (IT) platform and a systematic approach to prevention and population health management to achieve results. Outcome studies show particular success with diabetes care and management and improved compliance with routine screenings for breast, cervical and colorectal cancer (Table 1), Dr. Kownacki said.
At the outset, one of the challenges was to determine how Kaiser Permanente, a staff-model HMO, could “go into the workplace to create value internally,” he said. In order to measure value, KP needed to identify the prevalence of chronic conditions in the target population and their associated healthcare costs. Similar to national norms, health risk analyses revealed a relatively high incidence rate of diabetes and depression and related confounding health effects.
KP statistics on prevalence and cost per condition show that among its covered members, 5.8 percent of the population has diabetes and accounts for 19.6 percent of costs, while 4.2 of members diagnosed with depression account for 13.7 percent of costs.
KP conducted an analysis to compare co-morbidities among the population at NUMMI to norms using a variety of sources and electronic links to pharmacy, lab, diagnostics and other relevant data, including personal health records.
As a result, “a preventive health prompt at every visit is the core of what we do,” Dr. Kownacki said.
For example, if an injured worker undergoing treatment at the onsite clinic is due for a mammogram, the onsite provider recommends a screening exam during the initial injury treatment visit. Preventive health prompts are printed at every visit at every facility in the KP Health Connect system. KP Health Connect is a secure, HIPAA-compliant, web-based population health management tool that enables universal access to information populated throughout the broad delivery system.
The preventive health prompt lists all pertinent preventive care reminders specific to the individual patient; all providers in the KP system are considered responsible for reminding patients about the need for preventive health maintenance.
