Workplace clinics have come a long way from serving mainly as occupational clinics for workers' acute care medical needs.
Today's employer-sponsored on-site clinic is “a total population health management solution, not only treating acute conditions but also providing disease management and wellness, tobacco cessation and group support,” said Paula Andersen, director of Buck Consultants L.L.C.'s national clinical practice in Cincinnati. “It also might include dental, pediatric care, physical therapy, radiology and pharmacy. The clinics are becoming more of a one-stop shop.”
In some cases, “we've got clients whose population doesn't have access to a primary care physician, so those employers would be OK with employees treating the clinics as their medical home,” she said.
Shawne Cihak, client manager at Hub Colorado in Denver, which recently conducted a request-for-proposal process to help Colorado Springs, Colo.-based Spectranetics Corp. select a clinic vendor, said one local vendor's model came out on top because of its ability to serve as a primary care medical home.
“Their model is different in that it's physician-driven,” she said. “They rose to the top as the model that could have the biggest financial impact on controlling costs” by “engaging with teammates in a very proactive way.” Maybe they can “get people to comply with wellness” in the process, she said.
Clinics run by Paladina Health L.L.C. also include pharmacies that dispense 50 commonly prescribed drugs at a nominal cost to patients, said Jamie Doucette, chief development officer at Paladina, a division of Denver-based DaVita HealthCare Partners Inc. that operates 38 clinics coast-to-coast, of which about 25 are employer on-site clinics.
Moreover, “it's not just on-site or near-site, it's also tele-site,” said Terry Reams, senior vice president and employee benefits practice leader for Hub Colorado. “Employees can contact the doctor 24/7 by Skype or phone.”
Similarly, Sussex, Wis.-based QuadMed L.L.C. clinics also have become the medical home for many employers that have its on-site clinics, President Tim Dickman said. “We've always been a medical-home model.”
QuadMed has its origins in serving as a medical home for the employees of its parent company, Quad/Graphics Inc. Frustrated by soaring medical costs for the company's 9,000 employees, founder Harry V. Quadracci opened a small clinic at Quad/Graphics' plant in Pewaukee, Wis., in 1991. Today, QuadMed operates more than 90 employer-sponsored health centers in 18 states.
While clinics historically have been cost-effective mainly for employers with 800 to 1,000 employees in a single location, scaled-down models such as QuadMed's “Corporate Health Suites” are making them feasible for employers with as few as 250 employees on-site.
In addition, near-site clinics are growing in popularity among smaller employers and even large ones that do not have a big enough concentration of employees in a single location, said Josh Dunsby, a principal consultant at Mercer L.L.C. in San Francisco.
“There's been the traditional model where you need a certain threshold of employees to make it feasible,” he said. “Then there are near-site models that could take a couple of different forms. One form is an employer collective for the exclusive use of employees of a couple of companies.”
He said he has also seen primary care practices offer to provide clinic-like services to employers, charging a per-employee monthly fee.
“It's almost like paying for a fitness center membership. Employers have been interested in negotiating with a provider like that where they could get access without having to invest in the clinic themselves,” Mr. Dunsby said.
How workplace and near-site clinics are used “depends on the strategy of the employer,” said Robin Mancuso, managing partner in the health care practice group at Gallagher Benefit Services Inc., a unit of Arthur J. Gallagher & Co. in Itasca, Ill. “Many are there to be the primary care provider, especially in industries where employees don't have (primary care physicians). On the other hand, if you're talking about an organization where employees do have their own primary care doctors, those employers try to sell the on-site clinic as free support to the doctors in the community.”