Understanding what kind of companies can benefit the most from on-site, near-site employer care

Most of the discussion around on-site healthcare clinics highlight larger companies that offer the benefits to their employees as incentives for recruiting, retention, and improved health. In reality, however, there are different options available for on-site and near-site employer care that are appropriate for companies of all sizes.

Larger companies that have the resources can benefit significantly from on-site healthcare clinics. Establishing a clinic on the company’s premises may require hiring staff, investing in a facility, and funding all the necessary expenses of a private clinic. The rewards for the employer are seen in improved productivity and a healthier, happier workforce.

On-site employer healthcare clinics typically work well for large companies that have a limited number of facilities. Employees who work at satellite locations or other off-site facilities may not be able to take advantage of the employer clinic located on the campus of the main worksite. Most employers offer the on-site clinic services to employees’ families as well, so the on-site care will also benefit those employees who live relatively close to the company’s main site.

Large companies with multiple facilities and smaller companies may benefit more from offering their employees healthcare at a near-site clinic. As discussed in a recent article in Employee Benefit News (EBN), “For smaller, self-funded companies that do not have large budgets for additional benefit options, near-site clinics are certainly a more affordable option.”

Near-site clinics are run by an independent staff and require no start-up investment on the part of the employer. The clinics are shared by a number of employers, who generally pay a monthly fee to the clinic for providing healthcare services to their employees. Near-site clinics work well for smaller companies that do not have the resources to build a clinic on-site and for larger companies that have employees (and their families) scattered in various locations.

Roy Steiner
November 12, 2018


Global on-site care market is growing

Employers in the US are recognizing the benefits of on-site healthcare for their employees in growing numbers. Companies benefit from cost savings, improved productivity, and reduced absenteeism. Employees benefit from the convenience of accessing basic healthcare services such as preventive care, immunizations, and well checks, without losing time at work. Treatment for illness or injury is also made more expedient with on-site clinics.

The growth of on-site healthcare facilities is growing across the world as well. Future Market Insights (FMI) recently published a report, “On-site Preventive Care Market: Global Industry Analysis (2012-2016) and Opportunity Assessment (2017-2027)” that examines the global on-site care market. According to FMI, the compound annual growth rate (CAGR) of on-site preventive care is expected to grow 7.1% from 2017 to 2027.

In its report, FMI points out that the “standards set in the workplace for the safety of workers and the need to adhere to workplace norms have triggered the demand for on-site preventive care.” In addition, “the increasing incidences of workplace illness has also made it an obligation for employers to follow employee safety codes and adopt on-site preventive care.”

Over a third of the global on-site preventive care market share is held by North America. Western Europe follows closely. Within the North American market, the US market is growing as a “mature market,” in which many employers have adopted workplace wellness programs in addition to providing on-site healthcare clinics for their employees. Programs to help employees stop smoking, lose weight, and general maintain their health contribute significantly to the benefits of on-site care.

On-site healthcare clinics also help employers stay competitive across the globe. The benefit of on-site healthcare is used to attract and retain quality talent. Particularly in the US, where the unemployment rate is low and qualified workers may be challenging to recruit, the added benefit of on-site health, coupled with wellness programs, can be an enticing incentive to potential new hires.

Roy Steiner
November 5, 2018


ACOs and more advanced risk-taking models

Accountable care organizations (ACOs) that participate in the Medicare Shared Savings Program (MSSP) take on a certain level of risk, depending on the track they choose. There are three track levels, each with an increased amount of risk involved. Most ACOs choose Track 1, which has the lowest level of risk. In fact, in 2018 there are 561 Medicare ACOs in the program and 82% of them remain in Track 1.

The Centers for Medicare & Medicaid Services (CMS) recently implemented a Track 1+ as a time-limited CMS Innovation Center model. An ACO must concurrently participate in Track 1 of the Shared Savings Program in order to be eligible to participate in the Track 1+ Model. The Shared Savings models are currently:

Track 1 – Track 1 ACOs do not assume downside risk (shared losses) if they do not lower growth in Medicare expenditures.

Medicare ACO Track 1+ Model – Medicare ACO Track 1+ Model (Track 1+ Model) ACOs assume limited downside risk (less than Track 2 or Track 3).

Track 2 – Track 2 ACOs may share in savings or repay Medicare losses depending on performance. Track 2 ACOs may share in a greater portion of savings than Track 1 ACOs.

Track 3 – Track 3 ACOs may share in savings or repay Medicare losses depending on performance. Track 3 ACOs take on the greatest amount of risk but may share in the greatest portion of savings if successful.

According to CMS regulations, ACOs that began in Track 1 in 2012 or 2013 must move to a risk-based model by their third contract periods, which begin in 2019. A National Association of ACOs survey found that 71% of the ACOs that began their MSSP participation in those years are “likely to leave the MSSP if they must assume risk.”

The Association has asked CMS to consider revising its regulations, allowing ACOs to continue their participation in Track 1 an additional three years. Over two-thirds of the Association’s survey respondents said they would remain in the MSSP if the changes were made. The ACOs say “they need more time without risk because MSSP regulation has changed considerably since the early years and ACOs are just now operating successfully.”

Nick Dealtry
November 5, 2018


How smaller employers are taking advantage of on-site and near-site employer healthcare

On-site healthcare clinics have traditionally been a workplace benefit provided by larger employers. These clinics are typically located on company property and the clinical staff may actually be employed by the business. In fact, a recent survey conducted by the National Business Group on Health found that almost 50 percent of large employers, with over 5,000 employees, offer those employees the healthcare benefits of an on-site or near-site clinic. That number is expected to rise to at least 67 percent by 2020.

Smaller employers can also take advantage of the on-site or near-site clinic for their employees. The costs of building a facility and contracting or employing clinical staff, along with the increased liability issues, may seem prohibitive to small employers, but there are some creative solutions available.

Healthcare companies such as The Working Clinic are offering smaller employers a turn-key solution that eliminates the extra costs of building and maintaining an on-site clinic. According to The Working Clinic’s own description, it provides “convenient access to board-certified physicians for clinical examinations and on-demand doctor visits, occupational medicine services, and an on-site health coach and general medical liaison” with no start-up costs or build-out expenses for the employer.

Near-site healthcare clinics are another viable option for smaller employers. The services of a near-site clinic are also available with no start-up or build-out costs for the employer. Near-site clinics are generally already established healthcare facilities that contract with the smaller employer to provide primary care services, immunizations, and treatment for injuries or illnesses. In fact, the employees may find near-site healthcare clinics are more convenient for their family members, as many have multiple sites.

Smaller employers have several options available to them to enable them to take advantage of on-site and near-site healthcare for their employees. Instead of investing large sums of money in their own facility, they can either contract with a healthcare company that provides on-site services or with a near-site clinic. Either option provides healthcare benefits for their employees and cost savings for the employers.

Nick Dealtry
October 29, 2018


Understanding the social determinants of health and how they impact population health

A patient’s health status can be impacted by many factors, including genetics, eating habits, and physical activity (or lack thereof). There are a number of other factors that can affect a patient’s health as well, which cannot necessarily be treated with medications or traditional care plans. Social determinants of health are, according to the World Health Organization (WHO), “the conditions in which people are born, grow, live, work and age.”

For patients, social determinants of health, “circumstances (that) are shaped by the distribution of money, power and resources,” can influence their food choices and even whether they have access to quality healthcare. Social determinants include “intangible factors such as political, socioeconomic, and cultural constructs, as well as place-based conditions including accessible healthcare and education systems, safe environmental conditions, well-designed neighborhoods, and availability of healthful food.”

For healthcare providers, social determinants of health affect decisions made for population health management. The physician must take into consideration whether patients can afford to eat healthy foods, fill their prescriptions, and follow other plans of care that may be out of their range either financially or logistically. True value-based care can involve collaborating with community organizations and social service agencies to gauge needs and provide appropriate care based on the patient population’s circumstances.

The “complex interactions and feedback loops” of social determinants of health, as described in a recent article in NEJM Catalyst, include “poor health or lack of education (that) can impact employment opportunities which in turn constrain income. Low income reduces access to healthcare and nutritious food and increases hardship. Hardship causes stress which in turn promotes unhealthy coping mechanisms such as substance abuse and overeating of unhealthy foods.”

Value-based care for these populations will depend on the physician understanding the social determinants of health for the patient group, including the economic environment, employment opportunities, access to safe drinking water, and availability of quality food choices. Maintaining detailed patient data in electronic health records (EHRs) can help the physician track and manage the population health of patients who are impacted by these social determinants of health.

Healthcare professionals have available significant “data and research which indicates that the social determinants of health have a higher impact on population health than healthcare and that a higher ratio of social service spending versus healthcare spending results in improved population health.”

Roy Steiner
October 29, 2018


How to ensure employees are taking advantage of their benefits

For many consumers, healthcare has become complicated. There are various insurance plans with a range of deductibles and copays from which to choose. Employee benefits are often just as complicated, and many employees become confused as to what benefits are available to them and how to take advantage of those benefits. Even employees who have the benefit of an on-site or near-site healthcare clinic may not understand clearly how to use those services.

A 2018 Consumer Mindset Survey, conducted by Alight Solutions and the National Business Group on Health, found that “only 53% of individuals can understand and manage how they get health care services while just half understand and manage how to pay for these services.” In addition, the survey found that “a quarter of consumers say the health care system and benefits are so difficult that they give up and just hope for the best.”

The most effective strategy for ensuring that employees understand their options and take advantage of their benefits is clear and frequent communication with those employees. Communication designed to educate employees about the services provided by their on-site or near-site clinic and the costs involved can encourage employees to use those services more often. The employer-sponsored healthcare clinic may be a new concept to some employees who may not trust it or understand the extent of their benefits.

Communication and education can be accomplished in person or by taking advantage of technology. Face-to-face meetings, emails, an intranet page, and one-on-one sessions with a benefits counselor can help employees understand their benefits, encourage them to ask questions, and help ensure they take advantage of the benefits offered to them.

Taking the extra time and extra steps necessary to ensure full comprehension of the services offered by the on-site or near-site clinics, the family members covered by these benefits, and the costs (or lack of cost) involved in using the clinics can reap large rewards for the employee and the employer. When the employee takes advantage of the available healthcare benefits, the employer may see reduced costs and improved health among its employees.

Nick Dealtry
October 16, 2018


Accountable care organizations (ACOs) to know

The growth of Accountable Care Organizations (ACOs), those groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients, is evident in the fact that there are now 649 ACOs across the country. Becker’s Hospital Review recently compiled a list of 144 of those ACOs, “to highlight ACOs across the country and examine the opportunities for improving quality care and care coordination.”

Some of the ACOs on the list were established as long ago as 2008; some were just formed in January 2018. Some are based in large cities, while others are in small towns. A few of the ACOs to know, selected randomly from the Becker’s Hospital Review list, include:

ThedaCare ACO (Appleton, Wis.).  First established in partnership with Green Bay, Wis.-based Bellin Health in 2008, ThedaCare was selected for the CMS Pioneer ACO program in 2012. In three years, the ACO was responsible for nearly $14 million in savings for the federal government. ThedaCare ACO then became a Next Generation ACO to take on risk.

Heritage California ACO (Northridge, Calif.). CMS selected Heritage California ACO to participate in the Pioneer ACO Model in 2012. Heritage California ACO transitioned to the Next Generation ACO Model in 2016 to continue providing value-based care.

Kootenai Accountable Care (Coeur D’Alene, Idaho). The Kootenai Care Network is a clinically integrated network that includes Coeur D’Alene, Idaho-based Kootenai Clinic’s 200 providers as well as independent providers. Kootenai Accountable Care is a Track 1 participant in the Medicare Shared Savings Program.

LifeBridge Health ACO (Baltimore). LifeBridge Health ACO includes 594 participants and covers 19,000 lives. The ACO includes more than 160 primary care providers and more than 400 specialists. LifeBridge Health ACO participates in the Medicare Shared Savings Program and achieved quality scores of 100 percent in 2015.

NewHealth Collaborative (Akron, Ohio). NewHealth Collaborative is in its seventh year of operation. The Track 1 Medicare Shared Savings Program ACO includes 250 primary care physicians supported by 650 member and affiliate specialist physicians. The clinician-led ACO reported $3 million in shared savings for the 2015 performance year and distributed 63 percent of the savings to ACO participants.

UnityPoint Accountable Care (West Des Moines). The ACO is part of the CMS Next Generation ACO Model and reported $10.5 million in shared savings for the 2016 performance year. UnityPoint Accountable Care distributed 100 percent of the savings to ACO participants.

Signature Partners (Falls Church, Va.). Signature Partners is an ACO serving patients in Northern Virginia. As a collaborative of more than 1,700 physicians, the organization aims to use the clinically integrated network and EHR technology to better coordinate care.

Rio Grande Valley Health Alliance (McAllen, Texas). Seventeen primary care physicians make up Rio Grande Valley Health Alliance. The ACO is a Track 3 participant in the Medicare Shared Savings Program and reported $6.2 million in shared savings for the 2016 performance year.

Roy Steiner
October 10, 2018


The convenience of on-site, near-site employer clinics

Two major challenges for healthcare are cost and access. Even when healthcare costs are made affordable for the patient, or perhaps covered completely by health insurance plans, access often becomes an obstacle to being able to seek care and treatment. When care is made more convenient, however, more patients will take advantage of the opportunity for well care visits, immunizations, and acute care visits.

Patients are used to scheduling their appointments based on the physician’s calendar, rather than their own. They also typically would have to take time off from work, whether paid sick leave or unpaid time off, drive to the physician’s office, and wait in the physician’s office for their visit.

On-site and near-site employer clinics offer the convenience employees and employers seek. Employees who have access to healthcare services conveniently located on or near their workplace are able to visit the doctor for preventive services or to treat an injury or illness, without having to take significant amounts of time away from their job. The practical benefits of on-site and near-site employer clinics can be seen in increased productivity and reduced absenteeism.

Employees also increasingly want convenience as a reflection of their increased use of technology that enables them to access many other services from their phones or other electronic devices. To make on-site and near-site healthcare services even more convenient for busy employees, many primary care physicians practicing in employer clinics also offer telehealth visits.

Younger employees, in particular, want to access healthcare services at their convenience, using their phones whenever possible. Employees who take advantage of telemedicine services can generally speak with a primary care physician or other clinician via a phone call, describe their symptoms, and receive a diagnosis and any necessary prescriptions, all from the convenience of their office.

Technology and convenience can improve access to healthcare dramatically. The on-site and near-site employer clinics are increasingly providing both, encouraging employees to take advantage of their services, which in turn results in improved health outcomes for those employees.

Nick Dealtry
October 10, 2018


Advice on the management of complex patients

Primary care physicians who care for complex patients are often challenged with managing their care appropriately. Caring for complex patients involves the need to coordinate with specialty providers, to control the redundancy of tests, reduce the number of avoidable hospital admissions, and to curb costs for the patient and the provider. According to a study report published in the Rand Health Quarterly, “a relatively small proportion of complex patients … incur most of the nation’s health care costs” in the US.

The report, recognizing the challenges faced by primary care physicians in treating complex patients, states that “innovative uses of analytics and health information technology (HIT) may address these challenges.” Analytics, using various types of data, “may help create better risk stratification approaches that more effectively target patients for interventions.” HIT tools “may facilitate communication and improve timely decision making.”

Dr. Clive Fields, president of the Village Family Practice and co-founder/chief medical officer at VillageMD, writes in Physicians Practice that managing complex patients involves thought and planning on the part of the primary care physician. Dr. Fields also cites the need to take advantage of patient data collection and analytics, stating that the successful management of complex patients “involves implementing best practices, using data to identify opportunities for improvement, measuring outcomes, and creating a cycle of continuous improvement.”

Dr. Fields offers some additional advice on complex patient care. Primary care physicians should clearly understand their role in the care of complex patients. When multiple providers are treating the patient, as is usually the case, the primary care provider should take the lead in coordinating that care.

Primary care physicians should also know their patients well to better manage their care. They should be able to answer three questions, Dr. Fields suggests:

  •         Who are my complex patients?
  •         What illnesses and complications do they have?
  •         Where have they been in the healthcare system?

The answers can be easily attained by getting to know the patients more thoroughly as individuals and as part of a population group. Answers can also be found in the data contained in the patients’ electronic health records (EHRs), enabling primary care providers to coordinate and manage the care of their complex patients more efficiently and more effectively.

Roy Steiner
October 8, 2018


How is care quality measured?

Quality is not as easily measured as quantity. Terms like value-based care and quality care are increasingly used by healthcare providers as well as the Centers for Medicare & Medicaid Services (CMS) and even private healthcare payers. Measuring this care has become an integral part of the reimbursement and incentive system, particularly in the case of Medicare, but the question of how to measure quality care may not be clearly resolved for many providers.

CMS has launched a new Meaningful Measures Initiative to help define quality measures for healthcare providers. The Meaningful Measures areas are each linked to specific CMS strategic goals and, in fact, “serve as the connectors between CMS strategic goals and individual measures/initiatives that demonstrate how high quality outcomes for [CMS] beneficiaries are being achieved.”

Nineteen Meaningful Measure areas include such measures as Alcohol Use Screening, Use of Opioids at High Dosage, and Influenza Immunization Received for Current Flu Season, aligning with the CMS goal to Promote Effective Prevention and Treatment of Chronic Disease, for example. These areas have been divided into six quality categories as part of the Meaningful Measures Initiative:

  1.       Promote Effective Communication and Coordination of Care
  2.       Strengthen Person and Family Engagement as Partners in their Care
  3.       Promote Effective Prevention & Treatment of Chronic Disease
  4.       Work with Communities to Promote Best Practices of Healthy Living
  5.       Make Care Affordable
  6.       Make Care Safer by Reducing Harm Caused in the Delivery of Care

In addition, six cross-cutting criteria are applied to any Meaningful Measure area:

  1.       Eliminating disparities
  2.       Tracking to measurable outcomes and impact
  3.       Safeguarding public health
  4.       Achieving cost savings
  5.       Improving access for rural communities
  6.       Reducing burden

While quality can be a subjective term, particularly when it comes to measuring healthcare quality, CMS emphasizes that its new Meaningful Measure Areas are “concrete quality topics, which reflect core issues that are most vital to high quality care and better patient outcomes.”

Roy Steiner
October 8, 2018