Workplace clinics give literal meaning to the phrase "Taking care of our employees." However, savvy-thinking employers are taking strategic steps to determine what's in and what's out when it comes to health services rendered onsite.
"There are multiple models employers adopt on services and treatment offered by a workplace clinic," says Ha T. Tu, a senior researcher at the Center for Studying Health System Change and co-author of the study "Workplace Clinics: A Sign of Growing Employer Interest in Wellness."
"Some employers go with a full-service primary care clinic, while others decide the clinic will focus exclusively on wellness or physical therapy," she adds.
Intel analyzes claims intelligence
Early this year, Intel opened an onsite clinic in Hillsboro, Ore., the home to its Jones Farm campus. The new clinic serves about 5,700 employees and provides primary care, urgent care, allergy and flu shots, travel medicine, vaccinations and physical therapy.
Tami Graham, Intel's director of global benefits design, says the Intel team determined the services for their clinics by analyzing claims, and occupational and wellness data.
The plan was to figure out "what services could we offer, based on the scale of the worksite, that allowed us to offer better quality of care that is efficient and at a lower cost for employees," explains Graham.
In 2008, Intel, which employs about 43,000 workers, had launched two pilot onsite clinics in Arizona. "We conducted the Arizona pilots for a full year to better understand the business case for opening an onsite clinic," Graham says.
Overall, the Oregon model borrows from the Arizona one, which means it is staffed with a full-time physician, nurse practitioners, a physical therapist, registered nurses, certified medical assistants and health coaches. The team, however, did tweak the Oregon model, realizing that certain services might be in higher demand for that workforce.
One service that the company knew it wanted to offer onsite was overseas-immunization shots. "Many of our employees travel overseas to do business. As a result, they have to obtain a list of immunization shots to enter certain countries," says Graham.
In the past, Intel contracted with outside vendors to provide the costly immunizations. From a cost and convenience perspective, getting the shots onsite made sense, but it also made the process a better experience for workers.
"That is how we look at what's in and what's out regarding the clinic services - asking ourselves, 'Can we do it better and will employees value it if we put it in?'" Graham explains.
Using those criteria, physical therapy also made the cut. In the Arizona pilots, nearly 30% of the total visits were for physical therapy. The wellness data also showed some workers had health risks they were not addressing due to time, convenience and access.
Besides the capital investment of bricks and mortar, there are also the operating costs. Intel measures both pieces differently.
For example, the pilot programs for the Arizona clinics each cost about $3 million in capital investment and operating costs.
ROI metrics for the pilots focused on whether the $3 million in operating costs to provide the services was at least the same or less than the cost would have been if workers were to receive those services outside of Intel.
"We had a break-even goal on operating costs for the pilot and came very close to meeting it, but instead of 1.01, it was .96. We are now trending to goal with the Arizona clinics," Graham says.
The Jones Farm clinic cost about $1.2 million to build and the Ronler Acres Campus will cost about the same. It's roughly $1.5 million per clinic in capital costs, says Graham.
While ROI is important, it's not the only thing to consider when providing an onsite clinic. "Patient satisfaction is really important to us. If we did this and it saved money and people did not like it, then it was not worth it," Graham says. "Therefore, we take a pretty aggressive approach to our satisfaction goal, especially during the pilot stage."
For instance, the company sets a 90% satisfaction goal for the clinics, but is consistently hitting 95%. "In January 2011, we hit 98% on satisfaction goal with the Arizona clinics," says Graham, adding that employees consider the clinics as the best benefit program offered by company, and some use the clinic's doctor as their primary care physician.
Some health experts expect, with the uncertainty over the Patient Protection and Affordable Care Act's impact on the bottom line and more signs of a true economic recovery, more employers will open up workplace clinics.
"They have heard stories about health reform in Massachusetts where, in some cases, patients had to wait two or three weeks to see a primary care physician," says Peter Hotz, group vice president for Walgreens health and wellness division.
Expanding onsite health services is seen as a way to ensure employees and their dependents can see a physician in a timely manner, explains Hotz, whose company operates worksite health centers, as well as Intel's clinics.
In addition, Hotz says more workplace clinics are moving beyond just treating people when they are sick, but instead providing services to help employees become more aware of their health risks and manage those risks.
Part chiropractor, part coworker
Standard Process, Inc. is tucked away in a small Wisconsin farming community where it runs a 420-acre certified organic farm. The company produces whole food supplements using ingredients grown on the farm and employs 285 workers.
Since 1997, it has offered onsite chiropractic services, personal fitness training and nutritional counseling for employees.
"Our employees can go online anytime during the day to schedule an appointment with one of our chiropractors, and the visit can occur during the workday," says Jerry J. Curtin, director of human resources at the 82-year-old family-owned company.
Standard Process decided to focus on chiropractic services because it's a medical field that does more than just crack backs or do adjustments; it is a healthcare discipline based on the concept of "maintaining health" versus "treating disease." It also focuses on nutrition as part of the treatment, Curtin adds.
Employees are working in a manufacturing and farming environment that often requires hard physical labor. "As a result, we see our share of back, neck, elbow and shoulder aches and injuries," Curtin says.
"We think chiropractic services are a great opportunity to provide some medical care to our employees that also fit in with our overall philosophy of taking care of our employees. Standard Process is self-insured, "so we have an elevated interest in managing our costs related to benefits payouts," he adds.
The onsite health services, which include three chiropractors, one physical trainer and a nutritionist, are all located together in a designated area of the 286,342-square-foot facility.
The location is right next to the company's modern fitness center, and the three chiropractors have a room where they do their consultations. The company also houses a relaxation room and offers weekly massage therapy services.
"You have to view offering onsite services as a holistic approach to improving health and productivity, which means you have to be willing to put the time and money into the services," says Curtin.
"While we add these resources to our base cost, it pales in comparison to our annual cost savings related to health care costs. The health of our employees and their families is what keeps retention, engagement and the quality of work so incredibly high," he adds.
Another added benefit as to why a small company should add some onsite health services is that medical staff becomes part of the employee community. "Our employees work side by side with our health care professionals every day, so while Dr. Paul is seen as Dr. Paul, he is also the guy who goes out to lunch with folks and the guy you see at the Christmas party," Curtin says.
Those relationships make a big difference in people being proactive and taking care of themselves. For example, some middle-age and older men fall behind on their annual physical or are reluctant to follow up on health care needs.
"Yet, when you have a workplace relationship with a co-worker who is a physical trainer, nutritionist or chiropractor, then it makes it a lot easier to have personal conversations about being proactive in addressing one's health," Curtin explains.
According to the Center for Studying Health System Change report, onsite clinics may have a limited impact on direct health costs, but their presence offers employers more control over how health care is delivered.
According to HSC, industry research on the prevalence of workplace clinics varies, with one study showing that more than one-third of large employers offer onsite or near-site clinics, while another survey estimating one-fifth of large employers provide such clinics.
The Washington, D.C.-based policy group, which focuses on the U.S. health care system, reports its 2007 research revealed that 8% of American families had at least one family member who had used a workplace clinic.
The new research, conducted between February 2010 and July 2010, consists of an analysis of industry research and interviews with more than 35 workplace clinic experts, benefits consultants, clinic vendors and employers.
The study researchers found that employers with clinics viewed them "as a tool to contain medical costs, boost productivity and enhance their reputations as employers of choice."
In addition, today's clinics have moved "well beyond traditional niches of occupational health and minor acute care to offering clinics that provide a full range of wellness and primary care services," HSC researchers explain.
Workplace clinics also offer shorter waits and longer clinician-patient visits, which means the clinic's staff has more time to screen for other medical problems unrelated to the initial visit, according to the study.
Experts believed the clinics generated savings for employers because the venue represents "the ability to change practice patterns, such as drug prescribing, ordering of tests and procedures, and specialist referrals, along with the potential for early diagnosis and treatment to avoid emergency department visits, hospitalizations and other costly downstream complications." L.C.B.
Experts and employers offer insight on clinics
* The trusted clinician model of wellness/primary care delivery hinges on having the right staff. Through longer, more frequent face-to-face encounters, this approach emphasizes holistic rather than acute, episodic care but depends on finding and retaining clinic staff with the right skills and qualities.
* Sustained employer engagement is critical to success. Most employers outsource clinics to vendors, but experts noted that no successful clinic is completely a turnkey operation.
* Gaining employee trust is key to clinic acceptance. When clinics are first introduced, employees may be mistrustful of employer motivations, concerned about personal data confidentiality and skeptical about quality of care. Employers need to expect these concerns, communicate clearly and honestly about how the clinic fits into the company's core business strategies and demonstrate convincing evidence of patient privacy protections.
* Investing in the appropriate scope and scale of clinic services is challenging but essential. At startup, some employers take such a cautious and incremental approach that the clinic makes little impact on care delivery or cost containment.
* Other employers take a no-expenses-spared approach, building state-of-the-art facilities with comprehensive ancillary services - an approach that might pay off in reputation and brand but makes it difficult to recoup direct medical costs.
* Employers should be realistic about return on investment and recognize that measurement poses challenges. Employers should not expect clinics to be a quick fix for high health costs, because savings from population health improvement take time, even in the most effective programs.
Source: The Center for Studying Health System Change
