"The whole onsite clinic thing has been a buzz the last few years," says Michael Troup, partner at Forsite Benefits.

True enough. But the Forsite Health & Wellness Center is not your typical worksite clinic. Troup and his fellow partners at Forsite, Tim Mueller and Graham Ness, own and operate the clinic out of Forsite's headquarters in Green Bay, Wis., for use by any employees on their employer-clients' health plans.

The partners started to play around with the idea of opening their own clinic in April 2011 when working with a client that was interested in setting up an onsite clinic. They thought, why not create a cost-efficient model for employer-clients of any size to use? Already working with Prevea Health for their wellness program, myInertia, (also owned and operated by Forsite) the trio teamed up with the health care company to provide a nurse practitioner for the would-be facility.

For a $15 copay - an additional $10 for lab work - qualified employees receive top-notch care for a range of services, from acute care to chronic condition management.

"Our goal is to go after claims," says Troup. "And if we can go after claims, then we can help our clients. Benefits are becoming more and more of a commodity. I don't care how big of an agency you have; the actuaries are still dictating rates. If we can try to go after the actual claim aspect of things, we can start to control a little bit of the cost."

Combined with the myInertia wellness program, "it's all directed around claims savings and ... a dollar you can save on claims can correlate back to premiums," adds Troup. "So that's why we try to give an alternative out there."

Indeed, with an increasing number of employers moving to HSA-driven high-deductible health plans, Ness points out that while it's "created great consumers" out of employees, it's also "created some financial barriers" for many employees to properly manage chronic conditions.

"So you end up with people that are not compliant in the way that they should be," he says.

Having the Forsite Health & Wellness Center available creates a benefit for all involved, Ness explains, as it both removes a financial barrier and helps to increase compliance in managing these conditions for employees, while creating a positive impact for employers due to reduced utilization and claims costs.


How it works, who it's for

The clinic is "not a profit center for us," says Troup. "We're just trying to break even. We have to put some cost on it [for employees] so ... there's some skin in the game, but for employers there's no cost" to participate.

Although onsite clinics are typically appealing to self-funded employers, the system makes sense for Forsite's large number of fully insured clients as well, due to the high utilization of high-deductible health plans. "It's not unusual to see groups in the $3,000-$5,000 deductible range," says Troup.

While a lot of the cost savings goes to the employer on a self-funded basis, for fully insured plans the savings go to the employee. And if that's not enough incentive to use the clinic, many of Forsite's employer-clients have also decided to construct a plan design where they will pay the $15-$25 cost per visit, making the clinic entirely free for employees.

Not accepting of the prospect of sitting idly by as health care costs continue to rise and simply "delivering renewals every year and saying, 'Well, there's not much we can do. Here's your renewal,'" the partners now have a solution in the clinic, says Troup, "that can truly impact the bottom line."

While employers will structure their plans to encourage utilization, Troup finds the convenience factor has been a driver as well. Once one or two employees from a particular company use the clinic, word tends to spread, and more calls will come in for appointments. Anyone covered under the health plan, including family members, is allowed to use the facility.

Within the first couple of weeks after opening last fall, Forsite was getting positive feedback from participants. One employer was pleased to receive an email from an employee thanking them for making the clinic available. She explained how, up until that point, she'd been spending her $4,000 deductible on lab costs alone. "She's going to save about $3,600 a year," says Troup.

"It's one of the few business models where every party that's involved in this has something to gain," adds Ness. "The employer can offer a very low-cost benefit to their employees. So in an environment where we're taking benefits away quite often because of escalating health care costs, the employer now can say, 'Hey, here's something that we're adding in.'"

It's an opportunity that James Nooyen, business director at Green Bay's Home Instead Senior Care, appreciates being able to bring to his 30 plan-eligible employees.

"What it provided a lot of our employees was an opportunity to get some regular, ongoing treatment that they had done, where they were able to get that at a significantly reduced cost," says Nooyen.

While some of his employees have taken advantage of the clinic for sick visits, he notes one woman who estimates she'll be saving around $2,300 a year by using the clinic for chronic care treatment.

"It's a creative way to manage rising health care costs," says Nooyen, "and by taking away some of the added overhead and providing more direct access to health care professionals, it's better for the employer, it's better for the employee. And obviously it's better for the insurance company in the end if everyone is saving money. So I really think it's a creative way to save on health care costs."


Expansion plans

In the next six months, Forsite hopes to build upon the existing single clinic room and add physical therapy capabilities and two additional clinic rooms to the Forsite Health & Wellness Center.

With an eye on utilization rates, they also want to add hours and another nurse practitioner. The goal is to have the clinic open from 7 a.m. to 6 p.m. weekdays, with Saturday hours as well, says Troup.

"My ultimate advice is to partner with a health care system when doing it," says Rai. "That way your clinic has value to it. It has more than just a primary care base. It has access to a specialist; it has access to hospital information. And having the electronic medical record tied into all that [reduces] duplication."

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