Delivery models: Worksite healthcare

Healthcare today is being delivered in many sites other than the hospital, as Journal of Healthcare Contracting readers are well aware. Add the workplace – office building, factory, etc. – to the list.

Work is where people congregate during the day. They spend many of their waking hours there, they interact with the same group of people, day after day. Work is where bad health habits can fester – and where good ones can be nurtured and spread. So why not bring healthcare there?

The case for worksite clinics is strong, according to advocates. The employer wins, with increased productivity, reduced absenteeism, quicker return to work for employees, etc. And the patient wins too, as healthcare providers – doctors, nurse practitioners, physician assistants and others – work with employees to coach them on better health.

“We use illness to find wellness,” says Edward Schwartz, M.D., chief medical officer, CIGNA Onsite Health. An employee who comes in with a sore throat may get asked about his or her sleep habits, eating habits, etc. “We’re trying to go back to a holistic delivery system.

“Seventy to 80 percent of chronic conditions are lifestyle-related,” he says. “[Worksite clinics] offer a huge opportunity to not only prevent, but to sometimes reverse [chronic conditions]. It’s a fascinating dynamic.”

Market’s growing

“Demand is exploding right now,” says Stuart Clark, president, CHS Commercial Services, Reston, Va., which operates about a hundred worksite health centers. The company responded to 35 requests-for-proposal in 2009, and 58 in 2010. As of May of this year, CHS had already responded to 25. “Ten years ago, there were seven competitors; today, there are 35.” Private equity firms, health plans, healthcare providers and others are entering the market.

In February 2010, CIGNA Onsite Health – then just two years old – acquired Kronos Optimal Health to expand its worksite program, says Schwartz. “We had developed our own biometric testing capabilities, but we never realized how successful we were going to be. And we didn’t have the ability to provide services to everyone who was asking.” Based in Phoenix, Kronos focused on lifestyle management programs, face-to-face coaching, biometric screenings and health education programs.

Thirty-one percent of large employers offer a medical clinic at or near their workplace, according to a 2009 Mercer employer study. While most still use such clinics for occupational health services (which is where many got their start), 11 percent of large employers provide a clinic for primary care services and 10 percent of all employers surveyed are considering offering a primary care clinic this year. The Midwest Business Group on Health reports that 62 percent of workers are interested in their company offering onsite medical clinics to better manage their health, according to recent employee focus-group research.

In most cases, employers that are self-insured express the strongest interest in worksite clinics. They typically have a thousand employees or more in any one geographical region. However, smaller employers are banding together to create “near-site” clinics to serve their collective employees.

To read about what’s driving worksite clinics, read “Piece of Work,” in the latest digital issue of JHC