New research on workplace clinics observes that the clinics may have a limited impact on direct health costs, but their presence offers employers more control over how health care is delivered.
"While well-designed, well-implemented workplace clinics are likely to achieve positive returns over the long term, expecting clinics to be a game changer in bending the overall health care cost curve may be unrealistic," says Ha T. Tu, an 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 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.
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 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."
Emerging from the research were several common insights offered by experts and employers. They include:
The trusted clinician model of wellness/primary care delivery hinges on having the right staff. One of the most promising aspects of workplace clinics is their potential to transform the delivery of wellness, disease management and primary care by developing a relationship between a patient and a trusted clinician. 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.
Whoever runs the clinic, 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. Senior company leaders need to provide active, visible support at start-up and remain engaged throughout the life of a clinic. Achieving the appropriate balance between too much and too little corporate involvement is a challenge.
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. Employers also need to be patient in allowing employee trust to be built through first-hand personal experience and recommendations from early clinic users.
Investing in the appropriate scope and scale of clinic services is challenging but essential. At start-up, 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 (ROI) 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.
There are many challenges in accurately capturing ROI, and because workplace clinics are often implemented in conjunction with other benefit changes, isolating the impact of clinics on employer cost trends may not be possible.
And, while well-designed, well-implemented clinics may prove to be wise, financially viable investments for employers, the magnitude of savings is unlikely to make clinics "game changers" in bending the cost curve substantially overall.
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