Workplace Clinics: A Sign of Growing Employer Interest in Wellness
Most Workplace Clinics Offer Shorter Waits and Longer Clinician Patient Visits
Dec. 9, 2010
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, DCInterest in workplace clinics has intensified in recent years, with employers moving well beyond traditional niches of occupational health and minor acute care to offering clinics that provide a full range of wellness and primary care services, according to a new study by the Center for Studying Health System Change (HSC).
Employers view workplace clinics as a tool to contain medical costs, boost productivity and enhance their reputations as employers of choice, according to the study funded by the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization Initiative, which is administered by AcademyHealth.
Many experts interviewed for the study said most workplace clinics try to achieve a “trusted clinician” primary care model that offers much shorter appointment and in-office wait times and much longer clinician-patient encounters. Experts said that longer clinic visits allow the clinician—sometimes, but not always, a physician—to listen to patients, diagnose their conditions and discuss different treatment options with them. In addition, the clinician has time to screen for other problems unrelated to the immediate visit.
Estimates of clinic prevalence vary, with some recent employer surveys indicating that more than one-third of large employers offer onsite or near-site clinics, while another survey reported one-fifth of large employers doing so. According to HSC’s 2007 Health Tracking Household Survey, 8 percent of American families had at least one family member who had ever used a workplace clinic, and 4 percent had a family member who had used a clinic in the past year.
The availability of simple, routine care at work can be a valued perk for employees, but most experts observed that clinics’ direct cost-saving potential for employers is limited, if it exists at all. Instead, experts noted that what generates savings for employers is the ability to change practice patterns, such as drug prescribing, ordering of tests and procedures, and specialist referrals, along with the potential for early diagnosis and treatment to avoid emergency department visits, hospitalizations and other costly downstream complications.
“While well-designed, well-implemented workplace clinics are likely to achieve positive returns over the long term, expecting clinics to be a game changer in bending the overall health care cost curve may be unrealistic,” said Ha T. Tu, M.P.A., an HSC senior health researcher and coauthor of the study with Ellyn R. Boukus, M.A., an HSC health research analyst; and Genna R. Cohen, a former HSC health research analyst.
Based on a literature review and more than 35 interviews between February and July 2010 with workplace clinic industry experts and representatives of benefits consulting firms, clinic vendors and employers sponsoring onsite clinics, the study’s findings are detailed in a new HSC Research Brief—Workplace Clinics: A Sign of Growing Employer Interest in Wellness—available online at http://www.hschange.org/CONTENT/1166/. Common themes emerging from the interviews with industry experts and employers sponsoring workplace clinics include:
- The trusted clinician model of wellness/primary care delivery hinges on having the right staff. One of the most promising aspects of workplace clinics is their potential to transform the delivery of wellness, disease management and primary care by developing a relationship between a patient and a trusted clinician. Through longer, more frequent face-to-face encounters, this approach emphasizes holistic rather than acute, episodic care but depends on finding and retaining clinic staff with the right skills and qualities.
- Whoever runs the clinic, sustained employer engagement is critical to success. Most employers outsource clinics to vendors, but experts noted that no successful clinic is completely a turnkey operation. Senior company leaders need to provide active, visible support at start-up and remain engaged throughout the life of a clinic. Achieving the appropriate balance between too much and too little corporate involvement is a challenge.
- Gaining employee trust is key to clinic acceptance. When clinics are first introduced, employees may be mistrustful of employer motivations, concerned about personal data confidentiality and skeptical about quality of care. Employers need to expect these concerns, communicate clearly and honestly about how the clinic fits into the company’s core business strategies and demonstrate convincing evidence of patient privacy protections. Employers also need to be patient in allowing employee trust to be built through first-hand personal experience and recommendations from early clinic users.
- Investing in the appropriate scope and scale of clinic services is challenging but essential. At start-up, some employers take such a cautious and incremental approach that the clinic makes little impact on care delivery or cost containment. Other employers take a no-expenses-spared approach, building state-of-the-art facilities with comprehensive ancillary services—an approach that might pay off in reputation and brand but makes it difficult to recoup direct medical costs.
- Employers should be realistic about return on investment (ROI ) and recognize that measurement poses challenges. Employers should not expect clinics to be a quick fix for high health costs, because savings from population health improvement take time, even in the most effective programs. There are many challenges in accurately capturing ROI, and because workplace clinics are often implemented in conjunction with other benefit changes, isolating the impact of clinics on employer cost trends may not be possible. And, while well-designed, well-implemented clinics may prove to be wise, financially viable investments for employers, the magnitude of savings is unlikely to make clinics “game changers” in bending the cost curve substantially overall.
The Center for Studying Health System Change is a nonpartisan policy research
organization committed to providing objective and timely research on the nations
changing health system to help inform policy makers and contribute to better
health care policy. HSC, based in Washington, D.C., is funded in part by the
Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research.