Small busi­nesses, hos­pi­tals eye work­place med­i­cal clin­ics

Modern Healthcare - - News - By Shelby Liv­ingston

WORK­PLACE MED­I­CAL CLIN­ICS were once a ben­e­fit re­served for em­ploy­ees at only the largest com­pa­nies with the deep­est pock­ets. But now some ven­dors are help­ing groups of small and mid­size em­ploy­ers pro­vide con­ve­nient pri­mary care at shared clin­ics in hopes of tamp­ing down med­i­cal spend­ing.

Mean­while, as em­ploy­ers of all sizes grap­ple with ris­ing health­care costs and con­sider work­place clin­ics as one rem­edy, hos­pi­tal sys­tems are sign­ing up to staff those clin­ics to gain new pa­tients or keep ven­dors from steal­ing ex­ist­ing ones.

Many em­ploy­ers find work­place clin­ics can help lower health­care costs to the point they can put more money into pay­checks. “If a clinic is well-run, staffed cor­rectly so that providers are pro­duc­tive—that they’re see­ing your pa­tients—and the providers are re­fer­ring pa­tients to spe­cial­ists within the fa­vored net­works of the em­ployer, it will help to save money,” said Dr. Al­lan Khoury, a se­nior health man­age­ment con­sul­tant with Wil­lis Tow­ers Wat­son.

The In­ter­na­tional Brother­hood of Elec­tri­cal Work­ers lo­cal in Cincin­nati shares two such med­i­cal clin­ics with the lo­cal plumbers and pip­efit­ters union. Rick Fis­cher, busi­ness man­ager of IBEW Lo­cal 212, said med­i­cal spend­ing was eat­ing up union mem­bers’ pay raises each year, so he looked at the clinic as a way to curb those in­sur­ance costs and put more money into work­ers’ wages and pen­sions.

The union pays $26 per per­son per month—for about 2,400 mem­bers and their de­pen­dents—to a com­pany that is staffing the clin­ics, Ac­ti­vate Health­care. About 60% of the union mem­bers are us­ing the clinic, but their de­pen­dents are vis­it­ing less fre­quently. Fis­cher hasn’t cal­cu­lated a re­turn yet, but he said younger union mem­bers who rarely went to the doc­tor are now us­ing the clinic, which of­fers a well­ness pro­gram that could help pre­vent con­di­tions like high choles­terol and curb bad health be­hav­iors early. Lo­cal 212’s health and wel­fare fund shoul­dered the cost of build­ing a clinic at its union hall in Sharonville, Ohio, but Ac­ti­vate em­ploys the clin­i­cians who staff it. Fis­cher said shar­ing ac­cess to the plumbers and pip­efit­ters’ clinic about 30 miles away in Er­langer, Ky., al­lows Lo­cal 212 to reach more mem­bers with the ben­e­fit.

While smaller em­ploy­ers are get­ting into the game, large com­pa­nies are still more likely to of­fer their em­ploy­ees ac­cess to a med­i­cal clinic on­site or nearby. A third of or­ga­ni­za­tions with 5,000 or more work­ers pro­vided an on-site or near-site

gen­eral med­i­cal clinic in 2017, up from 24% in 2012, ac­cord­ing to a sur­vey by con­sul­tancy Mercer and the Na­tional As­so­ci­a­tion of Work­site Health Cen­ters. Among em­ploy­ers with 500 to 4,999 em­ploy­ees, 16% said they pro­vided a med­i­cal clinic in 2017, com­pared with 14% in 2007. Nearly a third of all the em­ploy­ers of­fer­ing a med­i­cal clinic shared it with other com­pa­nies in the area.

Re­turn on in­vest­ment

Most who have cal­cu­lated a re­turn on in­vest­ment said the clin­ics are pro­vid­ing pos­i­tive re­turns, the sur­vey showed.

Ac­ti­vate says health­care spend­ing can drop sharply, with cost sav­ings of 15% to 35% pos­si­ble by man­ag­ing work­ers’ health holistically in­stead of ad­dress­ing just the con­cerns they bring to the clinic, said De­bra Geih­sler, a prin­ci­pal at the com­pany.

Build­ing a clinic re­quires cap­i­tal that small em­ploy­ers of­ten don’t have. Smaller em­ploy­ers also lack enough pa­tients to make use of a full-time clin­i­cian.

But in the past sev­eral years, about 30 third-party ven­dors that op­er­ate work­place clin­ics have popped up, and many of them pro­mote clin­ics that lo­cal em­ploy­ers can share with lit­tle up­front in­vest­ment, said Larry Boress, ex­ec­u­tive di­rec­tor of the Na­tional As­so­ci­a­tion of Work­site Health Cen­ters, which was formed by the Mid­west Busi­ness Group on Health to sup­port pub­lic and pri­vate em­ploy­ers in get­ting

re­sults from their on-site clin­ics.

Ac­ti­vate’s clin­ics are staffed by a salaried physi­cian, ad­vanced prac­ti­tioner and two med­i­cal as­sis­tants, a team that can man­age 2,500 to 3,000 pa­tients.

Com­pa­nies with as few as five em­ploy­ees come to­gether to share the clinic. And be­cause the teams have ad­e­quate time, they can pin­point the root cause of pa­tients’ con­di­tions, make sure they un­der­stand their med­i­ca­tions, fol­low up on re­fer­rals and man­age chronic con­di­tions. Geih­sler said Ac­ti­vate pro­duces a re­turn on in­vest­ment for all of its em­ploy­ers.

‘Our re­spon­si­bil­ity’

“If we were in a com­mu­nity prac­tice, the minute the pa­tient leaves the door they’re re­ally not our re­spon­si­bil­ity any­more,” said Geih­sler, who pre­vi­ously served as CEO of the Har­vard Van­guard Med­i­cal Group in Bos­ton and Ad­vo­cate Med­i­cal Group in the Chicago area. “In our prac­tice, ev­ery­thing that pa­tient does is our re­spon­si­bil­ity when it re­lates to their health.”

Pa­tients don’t have co­pay­ments or de­ductibles to visit the clinic, which en­cour­ages them to en­gage with the care team, and providers earn bonuses based on pa­tient sat­is­fac­tion, par­tic­i­pa­tion and out­comes. Ac­ti­vate also dis­penses generic drugs at whole­sale prices, so there’s no markup from a phar­macy ben­e­fit man­ager.

Like Ac­ti­vate, em­ployer clinic op­er­a­tors One Med­i­cal, Pal­ad­ina Health and Cross­over Health prom­ise to help em­ploy- ers cut health­care costs and im­prove worker pro­duc­tiv­ity.

And pri­vate eq­uity in­vestors are bet­ting that the ven­dors have what it takes: Pri­vate eq­uity firm the Car­lyle Group in Au­gust in­vested $350 mil­lion into San Fran­cisco-based One Med­i­cal. Also that month, Den­ver-based Pal­ad­ina Health raised $165 mil­lion in fund­ing from a group of in­vestors led by New En­ter­prise As­so­ci­ates, which ac­quired Pal­ad­ina from DaVita a cou­ple of months ear­lier.

Provider part­ner­ships

Hos­pi­tal sys­tems afraid of los­ing pa­tients to th­ese third-party ven­dors are also strik­ing up part­ner­ships with lo­cal em­ploy­ers to staff their work­place clin­ics, though of­ten mostly with larger em­ploy­ers.

For sev­eral years, Nash­ville-based Van­der­bilt Health has part­nered with Metro Nash­ville Pub­lic Schools to pro­vide teach­ers and other em­ploy­ees con­ve­nient ac­cess to pri­mary-care clin­ics so they can be more ef­fec­tive in the class­room. Em­ploy­ees can visit any of the five ex­clu­sive health­care cen­ters avail­able at no cost. Four of the clin­ics are lo­cated in re­pur­posed mo­bile class­rooms at dif­fer­ent lo­ca­tions in the met­ro­pol­i­tan Nash­ville area.

The ad­vanced nurse prac­ti­tion­ers who staff the clin­ics pro­vide pri­mary-care ser­vices and help pa­tients man­age chronic dis­eases. The school dis­trict added a 26,000-square­foot brick-and-mor­tar clinic and fit­ness cen­ter last year, where em­ploy­ees can ac­cess more ser­vices in­clud­ing phys­i­cal ther­apy, be­hav­ioral health and a phar­macy.

David Hines, ex­ec­u­tive di­rec­tor of ben­e­fits for the school dis­trict, said the clin­ics see 500 pa­tients a week and are the med­i­cal home for about 35% of ac­tive em­ploy­ees. The dis­trict pays the en­tire cost of op­er­a­tions, plus a ne­go­ti­ated per­cent­age as Van­der­bilt’s earn­ings for the ser­vices pro­vided, he ex­plained. So far, the clin­ics have pro­duced sav­ings.

A RAND Corp. study of the school dis­trict clin­ics pub­lished in June found that teach­ers who used the clin­ics in­stead of a com­mu­nity-based provider had lower to­tal health­care costs and were less likely to be ad­mit­ted to the hos­pi­tal. On aver­age, the use of the work site clin­ics saved the dis­trict $62 per teacher per month in health­care costs, ac­cord­ing to the study.

David Posch, ex­ec­u­tive vice pres­i­dent for pop­u­la­tion health at Van­der­bilt, said part­ner­ing with em­ploy­ers en­ables the provider to take a proac­tive ap­proach to keep­ing pa­tients healthy and man­ag­ing chronic con­di­tions.

In re­turn, Van­der­bilt de­vel­ops re­la­tion­ships and fos­ters loy­alty among the em­ployer and staff to use its health sys­tem. The clin­ics, which use the same elec­tronic health record as the rest of Van­der­bilt, are able to keep pa­tients in the sys­tem by mak­ing re­fer­rals to Van­der­bilt spe­cial­ists when nec­es­sary.

Posch said Van­der­bilt is ex­pe­ri­enc­ing grow­ing de­mand among em­ploy­ers for on-site clin­ics and other ar­range­ments.

“We con­tinue to re­design our health­care de­liv­ery sys­tem to achieve value,” Posch said. “On-site clin­ics and part­ner­ships with em­ploy­ers are part of that ef­fort to look at how we im­prove health­care value for the pa­tient and the pay­ers.”

Nash­ville-based Van­der­bilt Health has part­nered with Metro Nash­ville Pub­lic Schools to pro­vide teach­ers and other em­ploy­ees con­ve­nient ac­cess to pri­mary-care clin­ics.

IBEW Lo­cal 212’s health and wel­fare fund shoul­dered the cost of build­ing a clinic at its union hall in Sharonville, Ohio, but Ac­ti­vate em­ploys the clin­i­cians who staff it.

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