Work-site clinics try to cover employees’ medical access gaps

The idea of workplace health benefits being limited to health insurance through work is giving way to health care delivered at work. The shift is driven by employers’ concerns about employees’ access to primary care and rising health care claims costs.

Work-site clinics have been around for decades, but analysts said they are becoming more numerous and are expanding services into what has traditionally been the territory of primary care physicians.

It’s difficult to find an exact number of companies offering work-site clinics, but Larry Boress, executive director of the National Assn. of Worksite Health Centers, said the new trade group was trying to assemble a comprehensive list. So far, he has counted more than 500 companies, including Disney, 3M, Toyota and Intel, that offer such clinics.

Employee benefits research firm Mercer polled “large” (500 employees or more) and “jumbo” companies (20,000 or more employees) about work-site clinics in 2011 and found that 27% of large and 36% of jumbo employers offered them. An additional 8% of large and 7% of jumbo employers were considering doing so in 2012 or 2013.

Meanwhile, a 2011 survey of large employers by consulting firm Benfield Research found that a third already hosted work-site-based clinics at one or more location, and 7% said they planned to within the next 18 months.

The prospect of expanded health insurance coverage under the Affordable Care Act had accelerated employers’ plans for work-site clinics, said Bruce Hochstadt, a partner with Mercer’s total health management practice.

“Presumably many of the 40 or 45 million people who are today uninsured are going to have better coverage, better access to care,” he said. “That could translate into reduced access for their employes when the floodgates open.”

Meanwhile, corporations are expanding services to include what has traditionally been the responsibility of primary care physicians, in part because they see employees having difficulties accessing traditional primary care.

Physicians are taking notice of the trends in workplace medicine. At its 2012 Annual Meeting, the American Medical Association’s House of Delegates is scheduled to consider a resolution calling for the AMA to study work-site clinics and develop guidelines for their operation.

Terry McGeeney, MD, is president and CEO of TransforMED, a subsidiary of the American Academy of Family Physicians that consults with physician practices to help them become patient-centered medical homes.

He said he had seen a “marked uptick” in recent months in inquiries from employers who are considering opening work-site clinics and want to “do it right” — provide high-quality care to their employees without alienating physicians in the community.

His answer is always to encourage employers to go first to their local health system or medical groups to ask whether they can meet whatever needs are going unmet. “It can be devastating if they establish a competitive environment,” Dr. McGeeney said. “If the employer truly sees a gap that needs to be filled, [it should] give the local community a chance to address it.” Some physicians also are finding new homes, and a refuge from the stresses of private practice, in work-site care.

Steven Pector, MD, left his family practice after 20 years to oversee care at Walgreens’ work-site clinic at its headquarters in Deerfield, Ill. He said he hated to leave his patients behind, but did not miss the uncertainty of private practice and “not knowing where that’s heading.” He sounded more sure about where work-site health is heading. It makes more sense for his patients to get health care at work than it might have even 20 years ago, he said.

Patients are so busy that if they are tied solely to a traditional primary care practice, they put off seeing a doctor and can easily miss the kind of screenings he does routinely for Walgreens employees. Dr. Pector was careful to emphasize that he doesn’t see workplace health replacing care outside that setting. He helps employees who don’t have a regular primary care physician to find one near their home, and recommends specialists who can help patients with services the clinic does not offer. At the Walgreens headquarters’ clinic, that is an ever-narrower set of services: Employees can take advantage of an on-site pharmacy, physical therapy, nutritional counseling and drug infusion services along with treatments for more common ailments. That’s in addition to a state-of-the-art fitness center.

Services like that are expensive, but the benefits can include savings due to the improved health of workers. More immediate results include less absenteeism, better productivity and higher employee satisfaction.

The prospect of long-term savings is appealing to businesses that are typically faced with raising premiums and scaling back benefits to keep health care spending under control. That has pushed companies that might have been hesitant to seriously consider work-site heath care, said Terri Hanlon, chief operating officer for TriHealth Corporate Health, a subsidiary of a Cincinnati-based health system.