How the convenience of worksite health clinics is changing the wellness game.
By Bruce Hochstadt
The era of U.S. healthcare reform may mean different things to different constituencies, but there’s no question that employee engagement in matters of health—and employer efforts to reinforce wellness—are increasingly valuable aspects of the new reform reality.
For example, we’ve noted among our clients a surge of interest in onsite health solutions, via worksite health clinics—many of which were created to deliver occupational health services for on-the-job injuries. But many of these clinics have expanded to include acute care services and provide basic, convenient care for minor health conditions.
The result? Improved employee productivity by reducing lost time and absence, improved disability outcomes, and better regulatory compliance. All of this helps to address the perceived risk that healthcare reform may compromise access to care, as millions of uninsured Americans receive coverage that could strain finite health delivery resources.
The complexities and potential increased cost to employers of healthcare reform are key issues. So organizations are looking for ways of getting ahead of the curve when it comes to employee health. Thus, the recent interest in worksite clinics goes beyond the traditional health center approach. Rather, employers are experimenting with new models for reaching their workers in smaller and more remote locations, focusing on the chronically sick/highest-risk plan members, and positioning clinics as onsite hubs to a company’s full range of health and wellness offerings.
Many employers have combined flexibility and innovation in the way they approach and leverage these centers. For example, most employers have implemented outsourced clinic models (clinic-staffed and managed by an external third party) for their populations. The significant growth in this niche has spurred the recent entrance of vendors, many of whom can offer near-turnkey onsite clinic solutions. Healthcare providers have joined in as well, attracted by the movement of employers to add health services to the worksite.
Providers are increasingly interested in piloting the accountable care organizations defined in the U.S. Patient Protection and Affordable Care Act (PPACA), as well as extending their health-practice reach to the worksite. However, a major risk that may arise when companies partner with providers for worksite health is the potential for excessive referrals of costly services (specialists, diagnostic testing, and procedures) to offsite community-based facilities. Performance guarantees tied to referral volume and steerage can help prevent that undesired outcome.
Another consideration is the shared clinic concept. These clinics can serve as a means for employers to share with other divisions or other companies the cost and responsibility related to an onsite clinic, especially if a single employer’s headcount at a given location may not generate sufficient volume on its own. A clinic based conveniently to more than one worksite has the potential to achieve many of the goals of the traditional onsite clinic concept with the added benefit of shared cost.
For smaller organizations that can’t justify a dedicated onsite health center or there isn’t one in the area to share, telemediated consultation—requiring a two-way video capability—is a possibility. Telemedicine may also be appropriate for remote locations with significant access shortages of both primary and specialist care, or where employees may need to drive long distances—often in excess of 50 miles—to see physicians.
In addition, companies are setting up occupational and even non-occupational onsite clinics as organizational hubs for health promotion and wellness programs. Services may include biometric testing, health risk assessment completion and review, face-to-face health and lifestyle coaching, as well as employee assistance plan services and chronic disease management programs.
Onsite clinics have begun to leverage technology, such as mobile texting, instant messaging, and email, to enable real-time notification of employees when the clinician is available to see them. This can greatly compress and in some cases eliminate clinic waiting times—usually the major frustration source for patients. And onsite clinics also can help to focus on the most at-risk members (those with diabetes, coronary disease, emphysema, etc.), who often require regular monitoring (blood sugar, hemoglobin, urinalysis, etc.).
In this era of healthcare reform in the United States and with so much global pressure for improved healthcare, employer-sponsored onsite health is an increasingly attractive option for issues of access, affordability, non-compliance, and follow-up. As an outsourced solution, its potential is powerful.
Bruce Hochstadt, M.D., is a partner and national onsite health leader in Mercer’s total health management practice, based in Chicago. He can be reached at bruce.hochstadt@mercer.com.
