If done properly, workplace clinics can save real money, one proponent says, noting that for every dollar spent, employers can save $1.50 to $1.60.
Hochstadt agrees. “It would flood an already overstressed system,” he says of expanded access to the nation’s uninsured and underinsured via federal health reform. “We see this as a real catalyst for employers to expand or accelerate their plans for workplace health.”
Some providers are drawn to on-site clinic care because they don’t have to deal with overhead or billing multiple payers and can get a chance to know their patients better. Typically, office visits are longer, too, Boress says. At Cisco, an office visit may be as long as 30 minutes or more.
Gibson says Cisco has had no problem recruiting providers; the issue has been finding the right fit. “The real challenge is making sure they are the type of person that wants to do comprehensive as opposed to episodic care,” she says.
Other employers are very concerned about a possible primary-care or specialty-care shortage related to federal health reform.
Quad/Graphics, a commercial printing company based in Sussex, Wis., operates five on-site clinics for its 20,000 workers and their dependents through its subsidiary QuadMed. QuadMed also provides on-site or near-site clinics to other employers, including MillerCoors and Northwestern Mutual Life Insurance Co.
John Neuberger, vice president of operations at QuadMed, says accessing primary-care providers in rural areas is already a problem.
“We do think there will eventually be a serious shortage of providers,” he says. “If we don’t manage that, it will have a serious impact on productivity. It’s a big deal for us to make sure we are caring for our employees. In smaller markets, it is a crisis.”
Quad/Graphics workers pay a flat fee of $8 per clinic visit. Workers get incentives to partic- ipate in on-site wellness programs in the form of reduced health insurance premiums. Today, Quad/Graphics has been able to keep its healthcare costs at 31% below its expected benchmark because of such programs. “It’s a major competitive advantage to us.” Neuberger says.
Like Cisco, QuadMed is expanding its use of telemedicine to reach employees at sites that don’t have on-site clinics and to address any immediate or long-term provider shortages. Three of Quad/Graphics’ clinics now offer nurse consultations to workers at other geographic locations. “Not everyone has access, so that’s our challenge for the next two years,” Neuberger says. “A lot of employers are jumping on this right now.”
A shortage of primary-care providers is prompting more employers to get into the business of on-site clinics, says Tracey Moran, marketing director for Marathon Health, which offers turnkey on-site clinics to employers. The Burlington, Vt.-based company has seen employers with as few as 200 workers express interest in the clinics.
As a result, more smaller and mid-size employers are exploring a shared-service model, with two or more businesses in nearby locations setting up a clinic together and sharing the access and the costs, Moran says. In May, two employers in Lincoln, Neb., announced an agreement to share a clinic set up by Marathon Health. Lincoln Industries, a metal finishing company, has about 450 employees, while nearby IMSCorp, an industrial manufacturer, has 200 workers.
The two companies see the clinic, dubbed Healthy U, as a medical home that will improve employee health and lower costs. “Opening the health center is the next step in our long history of wellness initiatives,” Tonya Vyhlidal, wellness/life enhancement director at Lincoln Industries, says in a statement.
La Penna says the shared-service model is an important trend because it opens up the on-site clinic concept to more employers, but that sometimes differences between the participating employers are too wide for the model to be successful.
In one case, a deal fell apart when a small manufacturer and a nearby retailer could not work out their differences over staffing, financing and other issues.
“We found too many governance issues,” La Penna says. “And there were cultural barriers we could not have predicted.”
Still, such pitfalls are unlikely to deter employers in the years to come, experts say.
“It’s more than just about getting a dollar return,” Boress says. “It’s about keeping people more engaged, compliant with their medicines and involved in their care.”<<