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.

Modern Healthcare - - Special Report -

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.”<<

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