In an effort to reign in health care costs and improve employee health and productivity, a growing number of employers are investing in on-site clinics. In fact, according to health and human resources consultant Mercers Worksite Medical Clinics 2012 Survey Report, between 2010 and 2012, the adoption of on-site clinics by employers with 5,000 or more employees increased from 32% to 37%; and another 15% were considering adding one by the end of this year. Among companies with 500 to 4,999 employees, 15% had workplace clinics, with another 11% planning to add one by the end of 2014.
While on-site clinics do, indeed, support population health and health care cost containment for both employers and their employees convincing employees to use them can be challenging. This is why a personalized, proactive engagement strategy one that educates and provides immediate opportunities for savings is a must.
Kansas City, Missouri-based Cerner Corporation, the largest standalone health care IT company in the world, recently initiated such as strategy.
With an annual health plan spend of $80 million and more than 20,000 lives covered under its full-replacement high-deductible health plan, Cerner wanted to make high-quality health care more convenient for those covered under its HDHP; it also wanted to reduce its annual health plan costs without sacrificing quality of care. The company accomplished this by engaging its employees and their dependents to comparison-shop for health care and pharmacy services, and by driving them to the companys on-site clinics and pharmacies.
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Cerner began by implementing proactive alerts, including ways to save alerts monthly emails or texts that proactively notify users of opportunities to save on their most common and recurring health care purchases and targeted engagement alerts highly targeted educational messages and reminders that support specific health and wellness initiatives.
Cerner identified the services that provided the greatest opportunities for employee savings. Then, it reached out proactively, every month, around those opportunities letting employees know that they were leaving money on the table and guiding them through the necessary steps to take advantage of savings.
Employees were also given access to Cost Lookup, an online tool from Change Healthcare, that helps users search for prescriptions, medical, dental and vision services, and see what they would pay at a specific provider based on their individual health plan, network and location.
On-site clinic use
The results of efforts to drive increased awareness and use of Cerner's long-standing, yet under-utilized on-site clinics were impressive. Of employees who were presented with an on-site pharmacy option in a targeted engagement alert that included multiple pharmacy options, and who purchased the service, 93% used the on-site pharmacy. Of those, 31% were first-time visitors to the on-site pharmacy and more than 50% went back to that pharmacy to fill an average of two additional prescriptions.
Similarly, 90% of employees who were presented with an on-site clinic option in a targeted engagement alert that included multiple clinic options, and who purchased the service, utilized the on-site clinic. Of those, 22% were first-time visitors to the on-site clinic and 34% returned to the clinic for at least one additional medical service during the 12-month period.
As an example, one particular user who acted on a targeted engagement alert highlighting an opportunity to save by switching from a community pharmacy to Cerners on-site pharmacy, saw claims-verified savings1 of $257 per refill, or $3,084 savings per year, for a single prescription. Another user, who responded to a ways to save alert by switching from a brand-name drug to a generic drug at Cerners on-site pharmacy, saw claims-verified savings of $506 per refill, or $6,072 per year, for a single prescription.
When using the Cost Lookup tool to search for health care services, engaged Cerner users performed an average of 4.3 Cost Lookup searches per year, demonstrating the sustained behavior change Cerner was looking for. Of those who followed through with prescription purchases, 79% returned to the same low-cost provider for an additional 3.4 refills on average. Of those who followed through with medical service purchases, 60% returned to the same high-value provider for an additional 1.5 visits on average.
One user, who comparison-shopped for medical services through the online cost-lookup tool saw claims-verified savings of $1,565 on a CT scan of the pelvis or abdomen.
In an analysis of the period from July 2012 to June 2013, 80% of Cerners employees received a ways to save alert or targeted engagement alert, and 66% of those alerts were acted on. The average savings per purchaser for medical services, when prompted by a proactive alert, was $138, while the average savings per purchaser for pharmacy services was $378 a total average savings per purchaser of $516.
Specific to the Cost Lookup tool, the analysis found that 55% of active employees logged in and searched using the tool. The average savings per purchaser for medical services was $141, while the average savings per purchaser for pharmacy services was $312 (a total average savings per purchaser of $453).
Ultimately, in addition to helping Cerner lower its annual plan costs and optimize the value of its on-site clinics, the effort increased employee engagement by over 60% throughout the year.
Yes, on-site clinics support population health and health care cost savings all-around, but only if employees are engaged to use them. This means that employers need an engagement strategy that is proactive and personalized one that creates awareness of the services and provides employees with the tools and information they need to shop for care and make value-based decisions. They want it 74% of consumers expect employers to educate them on healthcare, according to the 2013 Aflac Workforces Report. Are you prepared to deliver?
Doug Ghertner is president and CEO of Change Healthcare Corporation, a firm that provides cost and quality information to consumers through employers and health plans.
 To assess the value of the solutions on Cerner and its employees, Change Healthcare employed a savings methodology that analyzed actual claims data to verify that users not only engaged with the platform, but also changed behaviors and selected high-quality, lower-cost health care services. Change Healthcare developed its unique Claims-Verified Savings methodology in partnership with a health economist from the Bloomberg School of Public Health at Johns Hopkins.
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