With healthcare costs continuing to increase while quality, access, and satisfaction with the health system declines, many employers have decided to optimize their benefit dollars by offering an onsite or near - site clinic to their covered populations. This benefit solution is not limited to large manufacturers, as smaller employers can obtain the savings and improvements such a facility can bring to your bottom line, productivity and retention rate.
Worksite health programs were initially developed to provide first aid and emergency care to employees working in remote or dangerous locations. Over time many employers decided that offering a company nurse or doctor was an excellent approach to treat injuries and provide occupational health services to comply with federal and state workplace requirements.
The medical personnel, usually an RN, was also available to manage absences, prepare employees for foreign travel and provide a minimal level of acute care services. According to a recent survey by the National Business Group on Health, close to 50 percent of large employers -- those with over 5,000 workers, have onsite or near-site clinics - and by 2020, two - thirds will have such facilities.
Today, the services provided at the worksite run the entire spectrum of healthcare -- including not just medical, but dental, vision, physical therapy, chiropractic, lab, and pharmacy services. Leading employers are beginning to realize that by offering services that people leave work to obtain, they can reduce costs and better manage the health of their covered populations, while at the same time improving productivity since they'll have cut the time off the job by workers seeking medical care.
An employer-sponsored health center can serve as the hub of the worksite wellness wheel in integrating and analyzing all of the data from a vendor and employer-sponsored health-related programs and activities. At the same time, the onsite clinical staff increase the engagement of workers in the multiple preventive and condition management programs they offer. This type of population health approach efficiently identifies unnecessary services, gaps in care, opportunities for savings and quality variations to be addressed.
Employer-sponsored onsite and near-site clinics are evolving to support this type of population health management efforts by serving as "health and wellness centers" and medical homes. It's vital that such centers not add another fragmentation of healthcare to an uncoordinated medical marketplace, but connect the work-based care with a patient's care received at their primary care provider, if one exists.
The onsite health center offers the ability to be an extension of a patient's physician's office into the worksite. It also provides a source of primary and acute care for those 40 to 60 percent of employees who don't have a personal physician. Employers have found the local community providers an external healthcare marketplace - not a system - that offers limited access, uncoordinated care and no incentives to encourage people to manage their health.
Patients see their physician one or two times each year for only seven to twelve minutes per visit - hardly enough time to enable the provider or the patient to communicate or drill down on physical and mental health issues. However, people are at their workplace 1,000-2,000 hours a year, which gives the employer a tremendous opportunity to engage, educate, monitor and motivate employees to learn about and address critical health issues and conditions.
To enable employers to better understand and expand on the value of "health and wellness" centers, the National Association of Worksite Health Centers (NAWHC) was formed in 2012. The Chicago-based NAWHC is the nation's only non-profit association supporting employer sponsors of onsite, near-site and mobile health, fitness, pharmacy and wellness centers.
Often employers are reluctant to consider sponsoring an onsite clinic, over concerns about high costs, malpractice liability and reactions from local physicians. To address these concerns, about 60 percent of employers contract with third-party vendors and about 18 percent work with local providers. However, close to a third of employers have decided to manage these clinics and hire provider staff on their own.
Worksite health centers are not limited to manufacturers, though many started with an occupational health clinic. We find onsite and near-site centers sponsored by all industries, in both urban and rural communities.Willis Towers Watson has found employers who can benefit from having an onsite or near-site clinic include:
- Employers with 500 or more employees
- Geographic areas facing primary care shortages
- Locations with barriers to reaching external care settings (e.g., remote locations, long commutes, heavy traffic)
- Low utilization by employees/dependents of existing primary care, preventive, screening and condition management programs, and services
- Employers with populations with high emergency room utilization for non-emergency conditions or high absence and lost time for unscheduled medical issues; industries with low-turnover, long-term employees
- Older populations with high use of services and even younger people without primary physicians and with limited time
An onsite health center can serve as a vehicle to achieve many health benefit objectives, including efforts to reduce medical cost trend by avoiding utilization of unnecessary care; improving the health of the covered population; integrate all worksite healthcare, preventive and wellness programs; and reduce absenteeism, while improving productivity. The onsite health center offers an employer the ability to bring together the various vendors contracted to provide worksite wellness, screening and condition management services.
This can enable the employer to consolidate data from internal and external sources with health center's EMR. The presence of the clinic can also increase the visibility and access to other benefit programs and services, now available via a warm handoff between providers and vendors. The consolidated data now can track patient use of assistance and referrals and allow vendors to collaborate on a patient's care management.
Onsite fitness centers, often underutilized, can also be integrated into the health center's physical therapy and cardio programs. Finally, the integration enables easy collection and measurement of the center's performance and impact on the population's health and employer's benefit costs. Today's onsite health centers are taking advantage of new technology to go beyond their immediate service area and expand their services to patients when the clinic is closed, to remote locations and where sites are too small to support a clinic operation.
Telemedicine devices, kiosks, and carts, as well as retail clinics, mobile units, self-care apps on cell-phones and websites accessed on laptops are ingredients in the solution to total population health. With these resources available, NAWHC expects less than 50 percent of employee primary and acute care will be provided outside a physician's office within the next 5-7 years.
Tomorrow's onsite center will serve as the integrator and hub of an employer's health data and activities. In doing so, employers, with the cooperation and support of their vendor partners, will finally be able to take control of their healthcare spending, while assuring their workforce easy access to quality providers, at little or no costs. This will enable employers to achieve population health management and reduce cost while improving health, productivity and their firm's bottom line.
About the Author
Larry Boress is Executive Director of the National Association of Worksite Health Centers and can be reached at lboress@nawhc.org.
