Worksite clinics are a significant focus of our research for the 2012 Marketing and Planning Leadership Council national meeting series, which will launch this spring.
Staging for accountable payment structures
Most health systems are not making margins on these worksite clinics; rather, they expect to benefit from improved patient recruitment and retention within the employee base. Additionally, the worksite clinic model provides an opportunity to prepare for accountable payment structures—or reap savings achieved for the employee base where such structures already exist—improving system readiness for coming changes.
Basic worksite clinic models
For many systems, a base of 800 to 1,000 employees is necessary to sustain a clinic with a full-time provider, such as a nurse practitioner, with a PCP perhaps visiting two to eight hours per week. Larger employers can support a full-time PCP, as well as additional full- or part-time services, such as dental, vision, nutrition, rehab, and wellness. Smaller firms of 300-500 employees may opt for a part-time nurse practitioner-staffed model or join forces with other firms in a multi-employer model. Additionally, some employers are exploring the use of telemedicine and e-visits as a way to serve employees at smaller worksites or those who work from home.
Three common models:
Comprehensive primary care
- Intended to serve as employees’—and often dependents’—primary source of primary care
- Includes at least one PCP
- May offer extended hours but typically not weekends
- May include pharmacy, rehab, vision, dental, dietetics, mental health, and even specialist care available on a part-time or full-time basis
Basic primary care
- Intended to serve only as supplement to PCP practices but, in practical terms may be some employees’ primary source of care
- Treats minor injuries and episodic low-acuity illness
- Includes some disease management and evaluation of more complex conditions
- Offers screenings, health risk assessments (HRAs), and health education
- Staffed by full- or part-time nurse practitioner; PCP may visit two to eight hours per week
Occupational health model
- Intended to treat work-related illnesses and promote health awareness and education
- Treats minor injuries and low-acuity illness
- Offers screenings, flu shots, HRAs, and health education
- Staffed by full- or part-time nurse practitioner
Keys to effectiveness—regardless of model
Our research contacts have told us repeatedly that “you can’t over-communicate” the clinic’s scope of services. Help employees understand what the clinic offers and encourage them to seek preventive and chronic care in addition to urgent, episodic care. Some onsite clinics target outreach to specific employee groups based on their HRA results or offer massage, spa, or fitness services to encourage trial and build employees’ comfort with the clinic.
Utilization is critical both for achieving the cost savings needed to ensure the employer keeps the clinic open and guaranteeing patient recruitment and retention for the health system.
Establish referral protocols with the health system
Worksite clinics also must have strong referral protocols—often including scheduling the appointment for the patient—to system-affiliated PCPs and specialists, as well as EMR integration. Such protocols help ensure patient recruitment and retention, care continuity, and support from physicians who otherwise may be concerned that the onsite clinic will steal patients or compromise care quality.
Integrate with other employer services
One of the chief complaints we hear from employers is that health systems’ employer services are poorly organized. Onsite clinics, wellness services, and rehab services may be separately managed, requiring the employer to negotiate with several different teams at the health system.
Integration also facilitates better employee utilization of these services, and thus improved outcomes and cost savings.
Customize based on employers’ needs
Employers’ other primary complaint is that health systems are reluctant to customize their offerings to employers’ needs. For example, a health system may be unwilling to staff a clinic on a part-time basis only. Successful providers approach employers with a structured menu of several models which can then be refined and customized. This strategy allows the health system to offer a balance of guidance and choice that meets employers’ needs without overwhelming them with options.
Interested in learning more? Register for the 2012 Marketing and Planning Leadership Council national meeting series and check out our research briefs on Occupational Medicine Program Structure Across a Health System and System-Wide Corporate Medicine Programs.
Health Care Advisory Board members also may access a recording of the webconference, “Employers and the Medical Home.”