Commentary: As the reality of health care cost pressures continues to manifest itself, employers seem to be gravitating toward two poles. At one extreme, a number of employers are making substantial investments in population health management offerings, coupled with innovative payment models for care delivery. Perhaps one of the most common options among this employer group is worksite clinic services, particularly for those with reasonable workforce numbers that are geographically consolidated.
At the other extreme are the employers who are faced with more immediate cost pressures and typically have fewer internal resources and an organizational culture not conducive to engaging in health care supply chain management. For these entities, private exchanges may well represent an opportunity to secure at least some near-term cost savings through right-sizing of individual health benefits plan selection.
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At face value, these approaches appear to be mutually exclusive, originating from seemingly opposite philosophies asserting greater involvement with the health care delivery system vs. relinquishing control and relinquishing seemingly all but fiduciary responsibility for health benefits offerings. Yet, despite this seeming contrast, there is value in aligning these different approaches to achieve the same goal improved health outcomes and lower health care cost trend.
Worksite clinics: Value and limitations
Worksite clinics offer the promise of enhanced patient access and convenience, along with payment models that shift the focus from volume to outcomes. Use of worksite clinic services has been shown to improve treatment quality and medication adherence, presumably the result of improved patient-clinician relationships. Many of these clinics have successfully achieved formal recognition as patient-centered medical homes, appreciating the potential for improved care quality and outcomes, and lower health care costs largely through better chronic condition management and reduction in the number of avoidable hospitalizations and emergency department visits.
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However, worksite clinics have limited impact, particularly for those benefits enrollees who are geographically remote and unable to access the provided services. And while they may offer quality primary care, worksite clinics are often limited in their ability to systematically identify high quality, cost-effective community specialists or facilities for patient referral. This limitation can detract significantly from the ability of these clinics to meaningfully impact employer health care cost trends. Finally, at an operational level, worksite clinics typically have limited ability to integrate with community-based health data systems, thereby limiting more informed clinical decision-making.
Private exchanges: Value and limitations
In contrast, appropriately designed private exchanges have the potential to provide comprehensive population health management through strategic and operational integration among participating vendor partners. To achieve optimal effectiveness, comprehensive and timely data sharing and integrated analytics among exchange clinical vendors are essential.
Additionally, private exchanges are rapidly incorporating high performance networks, enabling access to objectively and systematically selected clinicians that are recognized for their quality, efficiency, and favorable outcomes.
Two other areas where some private exchanges are exerting a growing influence on enrollees are health care consumerism and well-being. Consumerism tools, including education, structured decision-support resources, as well as cost and quality transparency tools, are increasing in their importance to favorably influence individual health care utilization behaviors, particularly in the setting of high deductible benefit plan designs.
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Well-being is being increasingly embraced as a more holistic view of individual health status encompassing not only physical health, but also behavioral, financial and social health, as well. Incorporated by some exchange offerings as a core focus, this broader approach promises to address individual symptoms, be they physical, emotional or financial, and by so doing, improve overall health and workplace productivity. Employers that effectively address workforce well-being concerns have greater employee engagement, lower turnover, and more favorable business performance metrics.
Yet, by virtue of their nature, private exchanges have significant limitations. Because of their size, it is exceedingly difficult for private exchanges to engage individuals on a face-to-face basis to participate in available health management offerings. Despite reasonably timely data flow, it may still be challenging for private exchanges to provide efficient referrals to high-performing clinicians at such time they can provide the greatest value. And while electronic communication capabilities have substantially improved during the past few years, patient engagement remains less than optimal.
The whole is greater than the sum of the parts
It should be no surprise, then, that the respective strengths of worksite clinics with a private exchange are complementary. Furthermore, the respective limitations of each offering can be largely ameliorated through effective integration. Worksite clinics can benefit from uploading and integrating health management data from the private exchange to improve the effectiveness of care delivery. In return, the worksite clinics can serve as a hub for patient referrals to available private exchange offerings that extend beyond the clinics scope.
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Additionally, worksite clinics are perhaps best positioned to effectively engage individuals in their care, and introduce them to available decision support tools and other resources that the private exchange may offer. Private exchanges benefit from another data source to guide care management, and can serve as a bridge between the worksite clinic and a comprehensive array of well-being and clinical resources. Combined, these services offer substantial promise as a means to improve health and well-being, lower health care cost trend, and improve workforce productivity and performance.
Next steps
A thoughtfully integrated offering can provide a powerful boost to health care cost trend-bending efforts, in addition to improving workforce health, well-being, and productivity. Employers with worksite clinics may derive particular benefit from partnering with a private exchange that fully integrates the worksite clinic into the exchange offering. However, to be successful, the integration must be comprehensive incorporating timely two-way data flow, operational program integration, staff education, and a patient-centered approach to care delivery. Assessment of the effectiveness of integration should include metrics that reflect cross-program referrals, patient engagement and satisfaction, as well as clinical outcomes.
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Employers considering private exchanges may also want to think about the potential for concurrent implementation of worksite clinics in concert with their private exchange partner. Those with established worksite clinics may want to assess how incorporation of a private exchange and broader health management programs can effectively complement their existing worksite clinic offering.
Bruce Sherman, MD, FCCP, FACOEM, serves as the medical director, population health management for the
