Many employers have gotten a jumpstart on the wellness focal point that is part of the new health-care law (Patient Protection and Affordable Care Act (PPACA). Companies are providing care services at the workplace, building onsite clinics, which have become the hub of a wide range of programs that promote good health.
These new work-place clinics are incarnations of the occupational clinics that were a common fixture on plant grounds that were often plagued with work-site injuries. The expanded model includes broader services like primary and specialty care, pharmacy service, blood draws, X-rays, and physical therapy. Employers hope these clinics will produce behavioral lifestyle changes which factor into an employee’s every-day life.
Establishing and running a clinic is no small undertaking. Whether a standalone structure or a designated workplace area, the clinic constitutes a significant capital and operating expenditure.
Nonetheless, the trend continues to take hold. “There is no shortage of urban clinics in lower Manhattan,” says Bruce Hochstadt, who leads Mercer’s work-site clinic consulting group. “Most of the major financial institutions have worksites, as do the technology firms along Silicon Valley’s Route 101.”
The concept suits large, often self-insured employers, but many smaller firms are also hopping on the bandwagon, sharing clinics with other companies, or joining forces with a nearby hospital.
So, what is the motivator, especially in an uncertain economy where employers are striving to trim costs?
“Employers are on the hook for conditions like obesity and hypertension,” says Stuart Clark, president of Comprehensive Health Services (CHS), a provider of on-site health centers.
Clark ticks off the facts: diabetes is on the rise, even with younger people; 56% of hypertensive conditions are not controlled; and 25% of the U.S. health-spending goes toward treating cardiovascular disease. Pair all that with fewer and fewer medical students pursuing primary care specialties, and we could be headed for disaster. “In three years we’ll be faced with an access crisis as we add three million people to our health system.”
The clinics can help mitigate these risks. “We’re at work. We’re accessible. And your employer encourages you to use the facility,” Clark says.
As well your employer should. It’s a win-win. The employer recovers his capital in about 18 to 24 months and the clinic is a money saver year after year, Clark says.
Employer and Employee Benefits Hand-in-Hand
Clinic perks are not one-sided: Employees are typically responsible for lower co-pays, or are seen for free. Conservatively, Clark says, they can cut their per-visit health spending by 5% to 20%. What’s more, prescription drugs are cheaper with viable generics the drugs of choice at work-site pharmacies.
Companies attest to the savings. Health benefits insurer Highmark established clinics at two locations in 2009. Rich Little, vice president of compensation and benefits, says this year the company expects to save about $200,000. “It is cheaper for a company, its insurer and its employees to walk downstairs to a clinic to see a provider that’s getting an annual salary than to make a [fee-for-service visit] to a community provider,” Little says.
Collier Case, director of benefits for Sprint Nextel, says that in 2004, the wireless provider installed a clinic at the company’s corporate headquarters in Overland Park, Kan., and another at a large location in Reston, Va. He says that Sprint has identified several hundred thousand dollars in savings in the first year alone; the clinics have consistently driven savings ever since. That has translated into health-care savings for employees across the board, Case says.
It’s common for patients to visit a clinic doctor for one issue, and have the doctor find another important issue. That discovery--plus a follow up with an on-site health coach, a combined disease management and fitness program coordinated through the clinic in tandem with the company’s fitness center, nutrition management--all serve to limit downstream utilization, plus the associated costs and absences. The end game: a salve for employer productivity woes and a boon for an employee forging a career in an extremely competitive environment.
“Our emphasis is keeping employees at work and productive,” Case says.
Keeping employees at work and productive is what Hochstadt terms a “paternalistic benefit” that not only improves productivity, but also strengthens employee morale and influences retention and recruitment.
Here’s what visiting an off-site doctor entails: employees leaving their desk, getting to the doctor’s office, waiting to see the doctor, a process that could take hours. At a work-site clinic, seeing the doctor usually computes to a 45-minute stretch. Multiply the difference by thousands of employee visits and it levels quite a blow to lost work time and productivity deficits.
Don’t Rule Out Quality
Clinic practitioners come from top residency programs, says Hochstadt, dispelling a myth that the best practitioners gravitate only toward private practice. In fact, clinic practitioners provide service enthusiastically, thanks to being free from the pressures of private practice, he says.
Case says that at Sprint, trusted relationships have been nurtured between clinicians and employees, in part because of the high retention among the clinic’s staff: about 70% were on the original launch team.
Good service is also imperative. For example, long waits may be avoided through virtual notifications that signal an employee to stay at his or her desk until the doctor is ready, Hochstadt says.
While physicians have been slow to adopt Internet technology, businesses have not. “Most employers have not thought twice about investing in an electronic medical records system (EMR),” says Hochstadt. “About 80% to 90% of worksite clinics implemented EMR compared to only 15% to 20% of doctors. “
Sprint’s EMR bought them extra triage space within five months of opening. “Our file room had no files,” Case says.
At Highmark, electronic data is used to target disease states and analyze utilization for internal purposes. This also helps Highmark develop innovative products for clients and market with a more targeted approach, Little says.
Clinic benefits notwithstanding, experts agree that employers must continually communicate with employees to increase awareness and advertise events and services that springboard from the clinic. Companies should use a slew of tools to communicate services including online calendars and tools, and TV monitors earmarking special events. Word-of-mouth also goes a long way to promote use, Case says.
Highmark has a Web site wellness community. Much like Facebook, the site enables employees to use social networking to talk and research health—and all information leads employees to the clinic, Little says. Also, completion of the company’s five-step Lifestyle Returns program earns the currently 60% of employees who participate a year-end cash reward.
Employees also need to see and feel that executives support the clinic. “The top brass should be among the first patients,” Hochstadt says.
Our clinics have clearly driven a stronger relationship with our employees, whose level of commitment has paid off,” says Case.
Adds Little: “There is no silver bullet, but people need to understand that they must continue to play a hand in their own health.”