This is my fourth post in a five-part series on workplace health and safety trends for 2013, taking off on my forecast for 2012.
I predicted continued growth for worksite clinics featuring various permutations of occupational health, immediate care, primary care, rehab and prevention services for employees, and in some cases for dependents and retirees. I see this trend continuing with considerable delivery model experimentation.
Industry observers say a multi-disciplinary approach to care at the worksite holds the most promise for meaningful cost containment because it has the potential to alter practice patterns while simultaneously addressing work-related exposure and personal health risks. Interestingly, some of the hospital-affiliated occupational health programs and freestanding clinics with whom I am acquainted compete with national and regional organizations for on-site business opportunities by leveraging the established local referral relationships that some may prefer to see disrupted.
The “flavor of the month” in on-site clinics seems to be primary care, driven in part by the Affordable Care Act’s impending healthcare coverage provisions and the nation’s looming primary care physician shortage. For example, last month the global online travel company Expedia, Inc., opened a primary care clinic for 2,000 employees, family members and the general public at its Bellevue, Wash., headquarters.
Expedia’s provider partner says the new facility is part of a “transformative approach to healthcare” in Washington state that involves the development of a network of flat-fee primary care clinics. Patients who are not part of a covered population can pay a monthly fee ranging from $54 to $89, depending on their age and regardless of their health status. Proponents of this model estimate self-insured employers can lower their healthcare costs by up to 30 percent by offering flat-fee primary care as an alternative to traditional insurance-based primary care.
For Expedia, the new clinic symbolizes its commitment to workforce health and well-being. Connie Symes, executive vice president of human resources, said the company simply “can’t afford not to make preventive care a top priority for employees.” In the first month of operation, there were nearly 300 visits.
Like many other employers, Expedia believes having primary care readily available on-site will help reduce chronic illness-related costs and encourage employees to use their sick time and medical benefits more wisely.
Here’s another thing to ponder with respect to an on-site primary care trickle-down effect: Research shows workplace clinics are concentrated among large, self-insured companies. Consequently, only a subset of families have access to them, according to U.S. Families’ Use of Workplace Health Clinics, 2007-2010, a national study released last year by the Center for Studying Health System Change on behalf of the National Institute for Health Care Reform. The highest use rates were in the manufacturing sector, where 17 percent of families reported visiting a workplace clinic in the previous year.
Researchers said this reflects the historical importance of worksite clinics to manufacturers, which commonly rely on on-site providers to treat work-related injuries and other occupational health problems. At the other end of the spectrum were families with employees in the transportation or public utilities sector and in wholesale or retail trades (both 3.4 percent). The study found that on-site clinic users most commonly sought vaccinations and other minor, routine services rather than care for chronic conditions.
On one hand, the long-cherished primary care physician-patient relationship likely has something to do with this. On the other hand, extensive employer market research conducted by RYAN Associates in conjunction with the National Association of Occupational Health Professionals suggests about 50 percent of employees do not have a primary care physician.
This leads me to conclude that the success of on-site primary care clinics will largely be contingent on the ability of employers and medical providers to help employees and their families become exceptionally well-educated healthcare consumers.
UL’s occupational health solutions help employer clinics manage medical surveillance and clinic management, as well as vaccination, health and wellness, hearing conservation and other critical programs.