Editor’s inbox: Reader questions breadth of sources in article on onsite clinics


First published in Employee Benefit News, April 5, 2010

The article “Reconfiguring onsite health clinics” (EBN February) presented a remarkably limited perspective on modern clinics, resulting in statements like this one: “‘In a tough economy, an initial clinic approach should probably employ mid-level practitioners, such as a nurse practitioner or a physician assistant, because they are most cost-effective when rendering basic medical services,’ explains Mercer’s [Bruce] Hochstadt.”

Hochstadt may be right in terms of cost alone, but he is most definitely incorrect in terms of creating a medical home, or long term financial impact and return on investment.

What the article failed to appreciate or convey was that onsite clinics have evolved in several key ways over the last few years. Legacy clinic vendors tend to be heavy on bricks and mortar, and mostly run their clinics like old-fashioned doctors’ offices, with few electronic health records and certainly no personal health records, analytics or clinical decision-support tools.

Some have marginally effective call-center-based disease management and wellness programs, but often insist on copays to curb primary care utilization (as though that’s where the money is).

As the Sprint/Nextel example described, these structures are expensive to build and run. But they provide little substantive medical management that either swaps higher health plan costs (for office visits, drugs and labs) for cheaper costs inside the clinic, or creates meaningful influence over excessive downstream costs. So they often do not provide savings or quality improvements.

Newer onsite clinic vendors have developed more streamlined, easier-to-amortize physical plants. Rather than being just an occupational health or group health acute care clinic, they’re fully realized, flexible medical management platforms.

They are often physician-driven which, contrary to the article’s thesis, results in significantly greater effectiveness and ROI, and operate best outside of fee-for-service reimbursement. 
They induce employee/family participation through incentives like free office visits, free standard drugs and labs, which in turn lends them management control over a much larger portion of care.

They are heavily invested in Web-based health IT tools, a magnitude less costly and more user-friendly than older technologies. In other words, these clinics are machines that provide targeted solutions to longstanding structural flaws in health care delivery.

The failure to acknowledge these newer models suggests that no meaningful solutions are available in this sector. But some companies are consistently obtaining real group health savings of 15%-to-30% ROI in the first year, net of the clinic costs, while demonstrably improving quality.

Though more difficult to quantify, there also are more significant savings in occupational health – workers’ comp primary care, disability management, HR testing, retention/recruitment and lost work time.

Those interested in more contemporary, evolved clinics should look at WeCare TLC in Lake Mary, Fla. In addition, it appears that Marathon Health and HealthStat also are similarly focused on applying the best medical management lessons of the last 25 years, while serving as their employers’ fiduciary. In each case, these vendors’ employer-clients will vouch for the significant cost reductions they’ve experienced due to far more aggressive models than the article described.

Brian Klepper, Ph.D. Atlantic Beach, Fla.

About Brian Klepper

Brian Klepper is a health care analyst, commentator and a Principal in Worksite Health Advisors.
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