BHCG Monitor: Focus on Health Care Benefits
 
 

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Employer-Sponsored clinics – coming to a place near you?

While employer-sponsored clinics have been around for more than 70 years, it is safe to say their popularity has grown considerably over the last decade or two, and now have a presence in virtually every industry. As they have gained in prominence in the health care delivery landscape, they have grown more sophisticated in terms of their services. Employer-sponsored clinics have evolved from places staffed by nurses to treat minor illness and injuries to, in some cases, clinics that offer services such as preventive, acute and chronic care, wellness, occupational health, disease management and a host of ancillary services. These services are offered through employer-sponsored clinics developed using a variety of delivery, organizational and ownership models.

Defining the term

In the past, these arrangements have been typically referred to as on-site clinics. Over time this term has become too restrictive, as models have evolved whereby the care is not always provided on an employer’s site. For example, near-site clinics, where employers in geographic proximity share a clinic, have become commonplace. A more appropriate term, employer- sponsored clinic, captures the employer’s direct or indirect involvement in providing care, regardless of the specific location.

An increase in popularity

Recent surveys of employers show a clear picture – employers of all sizes are embracing the concept of the employer-sponsored clinic:

  • According to a 2013 survey by the National Business Group on Health, 44 percent of large employers have onsite clinics, and 9 percent were considering adding them.
  • Mercer's National Survey of Employer-Sponsored Health Plans, released in November 2012, indicated 37 percent of firms with 5,000 or more employees reported they offer occupational and/or primary care services through an on-site clinic, compared with 32 percent in 2010. Another 15 percent indicated they were considering installing a clinic within the next two years.
  • While slightly less popular with mid-sized employers, according to Mercer, approximately 30 percent of employers with more than 500 employees said they currently offer on-site clinical services, while 9 percent said they may begin offering on-site occupational health services, and 15 percent said they are considering offering primary health care services by 2014.
  • Estimates from various sources indicate that by 2015, on-site clinics are expected to serve more than 13 percent of the under 65 population in the U.S. compared to 4 percent in 2008.

Why employers are sponsoring clinics

As health care costs continue to escalate faster than general inflation, employers look at employer-sponsored clinics as another vehicle to slow that escalation. A 2012 Towers Watson survey of employers that have or plan to establish an employer-sponsored clinic indicated that reducing medical costs is the number two reason to do so.

Table 1: Top Reasons for Establishing and Continuing On-Site Health Centers

Source: Towers Watson 2012 survey

Beyond health care cost containment, employers adopting an employer-sponsored clinic strategy want to:

  • Enhance worker productivity (the number one reason noted in the table above)
  • Improve access to care, especially primary care
  • More fully integrate and coordinate wellness, health coaching and disease management programs
  • Address occupational health and safety needs

Services offered

The old adage, “when you have seen one of something, you have just seen one of them,” seems to apply to employer-sponsored clinics and the services they provide. At the simple end of the spectrum is what some refer to as minute clinics. They provide treatment for minor illnesses and injuries, usually provided by a nurse practitioner. They might ask basic health screening questions and provide preventive screening recommendations, but not provide the services themselves.

A full primary care model staffed by physicians and other providers is at the other end of the spectrum. It might offer convenient care for minor illnesses and injuries along with most primary care services, including annual physical examinations, medical screenings, test interpretations, ongoing recommendations and chronic disease management. It may also provide night and weekend on-call physician coverage or hospital admission management.  In between these two ends of the spectrum are a multitude of different combinations of services and staffing options.

Beyond primary care services, some employer-sponsored clinics may also offer or contract to offer services such as pharmacy, physical therapy, radiology, dermatology, orthopedics, pediatrics, dentistry, laboratory and behavioral health, among others.

Management models

Employers sponsoring clinics have adopted a variety of models to set-up and manage them. Some of the more common approaches include a single employer:

  • Owning and managing a clinic
  • Contracting with a local medical provider and either managing the business operation themselves or turning the management over to the medical provider
  • Contracting with an outside vendor who employs the staff and manages all the operations

Many times a single employer does not have enough employees concentrated in a specific geographic region to justify going it alone. In these cases, smaller employers have come together to share a clinic – the so called near-site option. In this scenario, multiple employers in relatively close proximity come together to own and manage the clinic jointly, or contract with an outside vendor or local health care system to operate the clinic.

Some keys to success

As with virtually any employee benefit, upfront, clear and consistent communication about the value of the employer-sponsored clinic is key to its effective utilization. Employers need an ongoing communications effort, clearly explaining the value proposition of the clinic. Beyond effective communications, others keys to success include:

  • Employees believing their health records will remain private and confidential
  • No cost or low cost for clinic services
  • A convenient, accessible location to the worksite
  • Visible involvement and support from senior management

Conclusion

The number of employers sponsoring clinics continues to grow as they look to control health care costs and improve employee productivity. With various management models and arrays of services to choose from, employers can adopt an approach tailor-made for their workforce and its unique needs.

The Business Health Care Group has conducted learning opportunities around the topic of employer-sponsored clinics. Please see slides and audio from a presentation in May 2014 to the Benefits Subcommittee by Patty Murphy of HNI and an executive summary and slides from an event co-sponsored with the National Association of Worksite Health Centers in September 2013.

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BHCG Monitor: Focus on Health Care Benefits - April 2012