Worksite clinics increase among large employers

The National Association of Worksite Health Centers (NAWHC) has found that a majority of larger employers offer onsite or near site healthcare clinics for their employees, a number that continues to increase. The association conducted a survey in 2018 that involved 109 employers, 80% of which had more than 5,000 employees. The survey involved manufacturing, healthcare, retail, education, and financial services firms.

Eighty of the employers responding to the in-depth online survey indicated that they offered a worksite clinic. NAWHC reports that adoption and growth of worksite clinics among larger employers, particularly those with more than 5,000 employees that are referred to as jumbo employers, is expected to continue. Findings from NAWHC’s 2018 survey include:

  • Among jumbo employers, 63% offer onsite clinics, 16% offer near site clinics, and 21% offer some combination to employees at multiple locations
  • Of employers with a worksite clinic, 51% plan to add an onsite or near-site clinic within two years, while 45% of those without a clinic plan to add one in two years
  • Just 12% of employers reported sharing an onsite clinic with other organizations, and 63% indicated they share a near-site clinic with others.

Among the many benefits to employees, including convenience of the healthcare clinic’s locations, the survey also found that the onsite or near site clinics become a medical home for employees of about 30% of the employers participating. Those employees did not previously have a primary care provider. About half of the employers offering clinic services open the benefit to include spouses and dependents as well.

Growth areas for the survey participants’ onsite and near site clinics include telehealth, physical therapy, chronic disease management, and behavioral health. In addition, more than half of the employers indicated that they provide worksite pharmacy services for their employees.

Most of the employers responding to the survey said they integrate their worksite clinic data with their health plan data to identify high-risk patients, to improve care coordination, and to measure comprehensive outcomes for their employees’ healthcare.

Nick Dealtry
January 28, 2020


How to evaluate an onsite clinic

An employer searching for healthcare options for employees may consider providing an onsite clinic as a benefit. There are many factors involved in determining whether an onsite clinic is the right fit for the employer and its employees, however. There are proven rewards for both when an employer provides onsite healthcare for its employees, but there are also a number of challenges and concerns. Evaluating a potential onsite clinic involves several factors.

One of the more positive aspects of onsite clinics is the fact that it provides convenient access to primary care services and to treatment of minor injury or illness. Employees can visit the physician without taking an entire day off from work, since the healthcare clinic is located on the employer’s campus. This convenience also serves to encourage employees to get their immunizations and other preventive services that would have taken too much time otherwise.

For the employer, the convenience of an onsite clinic helps to improve employees’ productivity, since they are less likely to spend excessive time away from work from work. The added incentive of maintaining their own well-being, through immunizations and preventive care, also helps keep employees healthier and less likely to spread contagious diseases while on the job.

Challenges, particularly for smaller companies, include the cost of establishing and maintaining a quality healthcare clinic. Larger businesses are still more likely to offer onsite healthcare, according to research conducted by Willis Towers Watson. Small businesses can take advantage of options such as sharing facilities with other businesses or contracting the service to an outside healthcare provider, rather than staffing and managing the service in-house.

Data security is a major concern for employees taking advantage of onsite healthcare services. Employees want to ensure their employer will not have access to their medical information. Onsite clinics must keep their patients’ data secure, but employees may still be skeptical given the close physical proximity of the clinic.

Ellen Kelsay, chief strategy officer at nonprofit National Business Group on Health (NBGH), an employers group in Washington, D.C., suggest that employers considering an onsite clinic should establish clear goals and investigate the pros and cons further. She recommends asking “What is the organization hoping to address and how will success be measured?” and states that employers should “be realistic about the time horizon to see success. Value may not always be derived in terms of hard dollar savings, but more in terms of softer costs such as productivity or engagement.”

Nick Dealtry
January 21, 2020


On-site, near-site clinics growing in appeal

The number of employers offering healthcare clinics either on-site or near site has increased significantly since 2012, according to a survey conducted by Mercer in 2018. The 2018 Worksite Medical Clinics Survey, a collaboration between Mercer and the National Association of Worksite Health Centers, was conducted in March and April 2018 and involved 121 employers. The businesses surveyed ranged from 150 to over 300,000 employees.

Significant findings from the survey include:

  • One-third of all organizations with 5,000 or more employees provide a general medical clinic at or near the worksite. That’s up from 24% in 2012 and from just 17% in 2007.
  • Two-thirds (67%) of survey respondents with general medical clinics allow members to select the clinic as their primary care provider, compared to just 49% of respondents to our 2015 survey.
  • Well over half of these employers reported a return of 1.5 or higher, meaning that for every dollar invested, they have saved a dollar and a half.
  • In 2018, 66% of the clinic sponsors responding to the survey have physicians on staff, compared to 52% of the sponsors responding to the 2015 survey.
  • Only 3% of survey respondents reported the average wait time in their clinics to be more than 10 minutes, reflecting the unique focus on patient experience in the fee-for-value employer clinic model.
  • Just over two-fifths (41%) of respondents are satisfied with their clinic’s navigation of patients to community value-based care, indicating a significant opportunity for improved member cost, quality and patient experience.

One concern that arose among survey respondents is the challenge for employees with health savings accounts (HSAs) in taking advantage of the employer clinic. The report states that “current IRS guidance states that having access to a worksite health clinic that provides significant medical benefits for free or at a reduced cost may prevent an employee from making or receiving HSA contributions.”

Half of the survey respondents offering a “medical plan eligible for a health savings account (HSA) believe that the requirement to charge members with HSAs for clinic services before their deductible is met has reduced clinic utilization.” The report adds that “Since both HSAs and worksite clinics are seen as positive ways to control healthcare spending, there is considerable support in Congress for legislation that would make it easier to employers to offer both.”

Nick Dealtry
December 9, 2019


The history of onsite clinics

Healthcare clinics physically located onsite at the employer’s facility are growing in popularity with businesses and with their employees. Offered as a benefit that has proven useful in enticing and retaining quality talent, onsite clinics provide the convenience of primary care services as well as lower costs for employees to access those services. While onsite clinics have been increasing in numbers in the past few years, their existence is anything but new.

Onsite healthcare services date back to the late 19th century. However, onsite providers were originally contracted to patch up workers that were injured on the job so they could go back to work quickly. Some companies provided a wider range of services to upper management, but most were focused on maintaining productivity levels.

During the depression of the 20th century, many companies laid off employees and even had to close their doors permanently, so onsite healthcare declined significantly as it was no longer needed. Once the manufacturing boom restarted, after World War II, more companies began offering the benefit again – and, in fact expanded the available services.

In the mid-20th century, the emphasis shifted to health and wellness, including prevention and primary care, and away from simply treating injuries. Companies such as Texas Instruments, Rockwell, and Xerox implemented employee fitness programs as part of their onsite healthcare. Employee Assistance Programs (EAP) also developed during the 1950s, with an emphasis on helping employees with work-life issues.

The Occupational Health and Safety Administration (OSHA) was established in 1970 with a focus on avoiding injuries and illnesses, further reinforcing the need for preventive care. Holistic wellness programs began emerging in the 1980s, expanding the services of the online healthcare center to include programs such as smoking cessation and weight loss clinics, nutrition education, and stress management programs.

Today, more employers are offering employees the benefit of onsite healthcare. A recent Mercer survey found that one-third (33%) of US employers with 5,000 or more employees offer general medical worksite clinics in 2017, a significant increase from 24% in 2012.

Nick Dealtry
November 1, 2019


Direct care and labor unions collaborate

Healthcare costs are of major concern to employers as well as to their employees. Companies that provide healthcare as a benefit to their team members face increasing premiums, often in a time when they also realize they need to cut operational costs. Employees can have high deductibles and copays that add to the cost of their healthcare premiums. Some of these companies have discovered that working with their employee unions on a solution proves beneficial to all.

While unions can have contentious relationships with company management, the United Auto Workers (UAW) national leaders collaborated with one of its members’ employers to reduce healthcare costs and to keep the company operations in the US. Spirit AeroSystems, based in Kansas, was searching for a way to reduce its expenses and determined that it might need to move its Oklahoma operations offshore, which would mean hundreds of lost jobs.

UAW national leaders pitched a new idea to the management of Spirit AeroSystems: a direct care model of healthcare, specifically “a direct primary-care provider newly formed with investment from another national labor union.” Spirit implemented the new healthcare plan, which reduced costs for the company and for its employees and was able to keep its operations in Oklahoma.

The direct care model is based on monthly membership fees and is focused on preventative care. Unlike insurance coverage, there are no deductibles or office visit copays. The collaboration between Spirt AeroSystems, the UAW local in Tulsa, and the direct care provider, SolidaritUS, began in July 2018 when three direct care clinics were launched. Each of those clinics cares for fewer than 1,000 patients so each patient receives personalized care. The direct care model also provides same-day appointments and after-hours access.

The results of the direct care and labor union collaboration have been “significant.” Visits to the emergency room and to urgent care clinics are down as are health plan premiums. Although employees were at first skeptical, patient satisfaction surveys are now “off the charts.” The collaboration between the UAW, SolidaritUS, and Spirit AeroSystems is “one of a growing number of examples of labor unions taking control of rising healthcare costs by reimagining such factors as how care is provided and how employers contract with pharmacy benefit managers for prescription drugs.”

Nick Dealtry
August 27, 2019


Employer health care costs expected to rise 6 percent in 2020

An annual survey conducted by PwC’s Health Research Institute (HRI) has revealed an increase in health care costs for employers as well as for their employees. The survey also indicates a number of unique strategies planned by employers to help reduce those costs. HRI surveyed health industry executives and benefits experts and combined those results with the results from a national consumer survey and a survey of more than 550 employers to compile the report, “Medical cost trend: Behind the numbers 2020.”

Among the key findings in the survey, HRI found that:

  • Drug spending will grow faster. Over the next seven years, “retail drug spending under private health insurance is projected to increase at a rate of 3 percent to 6 percent a year.”
  • Chronic diseases will continue to plague the populace. Chronic diseases such as diabetes and obesity contribute significantly to the higher costs of healthcare. HRI states that “sixty percent of adults have a chronic disease, with 40 percent managing two or more.”
  • Employees and their families will take advantage of greater access to mental health services. When employees are dealing with mental health challenges, the costs of their care can rise dramatically. HRI concludes that “in the long term, employers may find that addressing mental health is a powerful deflator of medical cost trend.”
  • Employers will continue to open more expansive worksite clinics. The survey found that “38 percent of large employers offered an onsite health clinic in 2019, up from the 27 percent that offered a clinic in 2014.” Another 13 percent of employers surveyed stated that they were considering offering their employees the benefits of a worksite clinic.
  • Employers and payers will nudge people toward lower-cost sites of care. Less expensive options such as telemedicine are growing in popularity with employers and employees.
  • More employers will help employees maximize their benefit packages. The survey found that “More than 80 percent of consumers surveyed by HRI with employer-based insurance would be interested in a ‘menu’ of options for care across virtual and physical settings.”

The HRI report concluded that “2020 likely will be, in some ways, a turning point in the long arc of employer-sponsored insurance, a year in which more employers fight back using new tools and strategies to control the ever-growing costs to their own organizations, their employees and their families.”

Nick Dealtry
July 23, 2019


What does an ideal EHR for employer clinics look like?

Employer sponsored healthcare clinics are particularly concerned with data security. Employees want to be sure their medical information cannot be accessed by their employer. An ideal electronic health record (EHR) solution for an employer clinic will not only be efficient and reliable but also safe and secure.

One of the main attractions of the on-site or near-site healthcare clinic for employees is the convenience factor. Typically, employees can seek out primary care services, immunizations, and treatment for minor illness or injury without having to take an entire day off from work. They expect the employer clinic to run efficiently and the on-site clinical staff to be able to easily access their medical data without any delays or other issues. The EHR used in the employer clinic must be able to offer that efficiency.

Often, an employee needs to be seen by specialty providers. The on-site or near-site employer clinic physician may need to collaborate with other physicians, labs, or healthcare facilities to ensure the patient is receiving appropriate treatment without duplication or error. An ideal EHR will also provide this capability, enabling the primary care physician to coordinate care without having to wait on medical files or care orders to be transferred via fax or multiple telephone calls.

Employees may have a primary care provider but use the on-site clinic for visits specific to an illness or injury. In those cases, the clinic physician can input visit notes and test results for the employee’s primary care physician to view. An ideal EHR solution enables the healthcare provider to view patient information, including visit notes, lab results, and prescriptions, with one touch. Likewise, communication between patient and physician as well as between multiple providers is seamless and secure in an ideal EHR.

Employer clinics are growing in popularity with both employers and employees. The convenience and cost savings are attractive benefits for recruiting job candidates and for retaining quality employees. A high quality EHR solution is key to offering employees the security and efficiency they expect in their on-site or near-site clinic.

Nick Dealtry
March 5, 2019


How on-site and near-site employer clinics can improve employee morale

Convenient access to primary care services in an on-site or near-site employer clinic has been shown to have many benefits for employees as well as for their organization as a whole. Employees who have the opportunity to take advantage of preventive care and immediate treatment for minor illnesses or injuries are physically healthier. Employers who offer on-site or near-site clinics as a benefit to their employees often realize lower absentee rates and higher production numbers.

On-site and near-site employer clinics can also improve morale among employees who actively use the services. Additional wellness benefits such as fitness centers or life management classes add to the benefits of the healthcare clinics. According to a recent survey of more than 1,200 full-time employees who work at companies with more than 3,000 employees, “providing a physical work environment that supports healthy decisions and participation in wellness programs (is) associated with reporting a positive work experience.”

The research, conducted by Optum, found that “employees who have access to 7–8 health and wellness program categories through their employers, compared to employees with no access to such programs, are:

  • 2.9X more likely to recommend their employer as a place to work
  • 1.5X more likely to continue working for their employer
  • 3.3X more likely to be proud to work for their employer

These numbers are indications of increased morale among the employees who actively engage in the employer-sponsored healthcare programs. Engagement is key to the results, and employees are more likely to engage in primary care services as well as health management programs such as weight loss or smoking cessation clinics that are convenient, either on-site or near-site.

The Optum study reports that “disengaged workers can be costly, both to the bottom line and to employee morale. In the United States, an estimated $450–$550 billion a year is lost to businesses due to less productive workers.” On-site and near-site employer clinics can help boost employee morale and significantly improve the bottom line for the employer.

Nick Dealtry
February 19, 2019


What employers want from on-site clinics

An on-site clinic is a healthcare facility that is located at an employer’s physical location. The on-site clinic offers employees easy access to basic primary care services and, in some cases, additional services such as pharmacies and fitness centers. The clinic setting can range from a single healthcare provider offering immunizations and well checks to a fully-staffed facility equipped with multiple options available for employees and their families.

Generally, an on-site clinic has as its goal, “easy access and immediate attention, at little or no cost, for a host of services and products that an employee would normally have to leave the worksite to obtain.” What are the top priorities for employers who offer their employees the convenience of access in an on-site clinic?

According to the 2016 Healthiest Employer® “Onsite Workplace Clinic Survey” of employers, brokers, and vendors, employers want two basic outcomes from their on-site clinics. Their top priority is employee health and productivity. In fact, many employers are expanding the basic immunizations and preventative primary care services to include wellness centers, life management programs such as smoking cessation, and other services designed to help employees improve and maintain their quality of health.

Employers’ second most important priority when offering employees on-site clinic services is healthcare cost reduction. Healthcare costs are rising, for employees and employers. On-site clinics can help keep some of these costs in check. In addition, the convenience of access to healthcare encourages more employees to visit a physician when they are ill or to prevent becoming ill. As a result, absenteeism and presenteeism (showing up for work when feeling ill and possibly contagious) are reduced significantly.

The study also found that those employers who do not offer on-site clinics have somewhat different priorities. According to its findings, “fewer than half of employers without onsite clinics have invested in disease management or smoking cessation, and barely half have invested in health coaching or weight loss interventions.”

Nick Dealtry
February 6, 2019


How DPC care can segue to direct-to-employer care

Change is generally a challenge, particularly in the workplace. Employees who are told they must change their healthcare plan may not always react positively. In fact, employers may not want to change their company healthcare plan, at least not all at once. One option is to segue to a new plan in small steps, especially when it entails a new concept, as is the case with direct primary care (DPC).

DPC practices are a relatively new breed but are growing in popularity. The DPC model involves patient membership fees rather than insurance reimbursements, as well as more direct involvement by the independent physician. The DPC practice harkens back to the day of the family doctor. House calls, after hours communications, and personalized care are among the benefits cited by DPC physicians and their patients.

Employers have moved slowly toward the DPC trend but are still somewhat hesitant to forego traditional healthcare coverage completely. One option is to offer employees the choice of a health insurance plan such as a PPO product in addition to the DPC practice. That’s exactly what one company – a large healthcare provider itself – has done for its employees.

CHI Health is the Catholic Health Initiatives (CHI) division for Nebraska and southwest Iowa. In 2017, CHI Health launched its own DPC practice to augment its traditional healthcare services. The DPC was designed to care for CHI Health’s own employees primarily. CHI Health employees are given the option of enrolling in traditional PPO coverage or participating in the DPC. Approximately 1,130 of the organization’s 20,000 employees and beneficiaries opted into the DPC model during the first quarter of 2018.

Employees were reassured that if they needed care beyond the basic primary care services provided by the DPC that they could seek out specialty providers and other catastrophic services such as hospitalization for the same deductible costs as the PPO-covered employees. However, according to HealthLeaders, “early results suggest DPC participants use these more-expensive options less.”

In fact, the costs were significantly lower for DPC-covered employees during the first quarter of 2018. Facility and specialist claims were 20% less for those employees in the DPC practice than for those employees enrolled in the traditional PPO plan.

Employers can test the waters by segueing employees to a DPC practice, offering the choice for those who do not readily accept the change. After demonstrating both cost savings and improved outcomes, the DPC may be seen as the preferred choice for all going forward.

Nick Dealtry
January 22, 2019