How to Generate Healthcare ROI Through an Employer-Sponsored Health Center
The medical risk management approach
U.S. employers are searching for strategies to provide high-value employee health care. They want to more effectively manage health care cost trends – still rising at more than twice the rate of inflation – and get the greatest value from dollars invested.
Forward-looking employers are turning to on-site (also known as near-site or employer-sponsored) health clinics, an innovative delivery mechanism to bring health care directly to workers on the factory floor or in the office complex. Such clinics hold the promise of helping to proactively manage costs, reduce absenteeism and improve quality.i
In 2014, 32 percent of employers with 1,000 or more workers offered employee health clinics, according to a Towers Watson-National Business Group on Health 2013/2014 report.ii The report’s authors identified offering on-site care one of the top 10 tactics for managing health care costs. A 2014 poll found that 29 percent of self-funded employers with 5,000 or more employees offered work-site clinics. Smaller and medium-sized employers are joining the national momentum by teaming up to participate in on-site clinics, in some cases through business coalitions.iii
The founders of WeCare tlc, a medical risk management company that uses on-site clinics to manage employers’ population health risks, believe that clinics are most effective when they offer comprehensive primary care.
WeCare tlc, with 55 clients in five states, does not just operate employee health clinics; the company builds patient-centered medical homes (PCMH). WeCare tlc then uses those homes as a platform for medical risk management and for improving the overall health of an employer ’s population. The company ’s data analytics team continually evaluates employers’ historical and current health claims to customize medical offerings, add services or more tightly manage the network – all with an eye to improving worker health and driving down costs.
This paper will examine four significant ways the WeCare tlc patient-centered medical home model and comprehensive medical risk management approach are improving employee health and employers’ bottom lines.
Too often, on-site clinics fail to meet their full potential. In September 2015, global human resource consulting firm Mercer published these troubling findings:iv
of self-funded employers’ workers use clinics when they are offered.
of self-funded employers’say the clinic helps members control chronic conditions.
say their clinics are delivering a return on investment.
WeCare tlc’s results prove the value of its approach:
of our clients’ workers use our clinics in the first year. That grows to more than 80% in the second year.
of employees would recommend WeCare TLC clinics to a fellow employee.
↑ 3 years
Employers covered the cost of the clinic, eliminated medical inflation and reduced overall health plan costs within three years.
Employers lowered their health care costs by 15 percent to 25 percent.
The WeCare Physician-Led Primary Care Medical Home
On-site clinics come in a variety of shapes and sizes. Most frequently, nurse practitioners or physician assistants lead them. Some are led by physicians or registered nurses. Nearly all employer-based clinics offer urgent care – such as immediate care for upper respiratory or urinary tract infections, a recent survey found. Most offer blood draws and routine preventive care, such as vaccinations. Four out of five clinics offer wellness services and two-thirds offer health coaching; between one-third and one-half of clinics also offer pharmacy.v
The founders of WeCare TLC believe that to truly manage health plan costs, on-site clinics must become the primary point of contact for all employees’ health care needs. Only then can providers build long-lasting, trusted patient relationships that lead to better health. That’s why WeCare TLC clinics are organized as patient-centered medical homes (PCMH), an evidence-based model that lowers costs and improves quality.
What is a Patient-Centered Medical Home?
According to the American Academy of Family Physicians,iv a PCMH is:
Physician-led: Each patient has an ongoing relationship with a personal physician who provides continuous and comprehensive care.
Oriented to the whole person: The care team provides comprehensive care, including acute care and chronic care at all stages of life.
Integrated and coordinated: Care managers take steps to ensure that patients receive all the care they need within the clinic and community.
Focused on quality and safety: It uses continuous quality improvement and evidence-based medicine to monitor and improve outcomes.
Accessible: Clinics commit to enhancing patients’ access to care.
A growing body of research is providing evidence that PCMHs curtail overall health care costs by reducing inpatient visits, emergency department use and hospital readmissions.
For more information about the PCMH model, read the National Committee for Quality Assurance’s Latest Evidence: Benefits of the Patient-Centered Medical Home or the National Committee for Quality Assurance’s Patient-Centered Primary Care Collaborative’s The Patient-Centered Medical Home’s Impact on Cost and Quality: An Annual Update of the Evidence 2012/2013.
Study Proves the Value of Employer-Based Medical Homes
SAS Institute Inc., headquartered in Cary, NC, has operated an on-site health center for more than 30 years. A new study by SAS and Duke University, published in the July 2015 edition of The American Journal of Managed Care, makes a strong case for encouraging employees to make the health center their medical home.
The study divided SAS employees and their dependents into three categories:
Major users – those who designated the SAS on-site clinic as their medical home.
Casual users – those who identified community medical providers as their medical home, but used some on-site clinic services at least once.
Casual users had the highest health plan costs of the three groups. Major users who made the clinic their medical home saved SAS $482 per year in health care costs when compared to casual users. Most of the difference ($283) was for pharmaceutical costs. future health care costs.
As for dependents, the difference was even more dramatic. Dependents who were casual users had the highest claims costs, followed by nonusers. Major users saved SAS $600 per year in health care costs when compared to casual users, and saved $330 a year in claims costs when compared to nonusers.ix
The Value of Team-Based Care
The WeCare TLC PCMH relies on a team to deliver care. Instead of a physician trying to accomplish everything in a 20-minute visit, a clinical team – a physician, registered nurses, medical assistants and licensed practical nurses – cares for the patient.
For example, the medical assistant checks in the patient, draw blood, performs eye exams and other screenings. The physician designs and supervises the treatment plan. The registered nurse educates the patient in self-care and oversees care plan implementation. The licensed practical nurse dispenses medication. All these interactions are recorded in patients’ electronic health record, furthering care coordination.
From a patient’s perspective, this means more time with the physician. Freed up from routine tasks, WeCare TLC physicians spent at least 20 minutes with each patient; 40 minutes spent on the first visit. Patients also enjoy the convenience of one-stop shopping. In one visit, patients can receive a flu shot, get a test done, see their doctor and receive needed medications.
Research shows that team-based care improves patient satisfaction and confidence in their health providers.vii One study of a patient-centered medical home compared medical home patients with those who visited a traditional clinic. PCHM patients reported higher degrees of satisfaction across the board, including measures such as the quality of their doctor-patient interactions; the degree of shared decision-making; the coordination of care; their access to care and the helpfulness of office staff.viii
Research also shows team-based care improves quality. First, everyone from the physician to the medical assistant to the nurse brings his or her unique clinical preparation to the patient. In addition, because all providers work together, gaps in care are fewer.
The Staffing Model
Physician: Sets the care plan; evaluates all the data and information to make modifications to the care plan; performs minor surgeries and refers patients to specialists if needed.
Nurse practitioner: Cares for lower-risk patients and provides urgent care.
Registered nurse: Talks to patients who have symptoms; follows up on complicated test results; coordinates pre- and post-surgical care; educate patients on their conditions and coaches patients in self-management. RNs also serve as health coaches, manage the care for individuals with complex conditions and implement disease management programs.
Licensed practical nurse: Renews prescriptions and follows up on abnormal (but not complicated) test results.
Medical assistant: Schedules patients and performs blood draws and simple examinations.
WeCare tlc Financial Impact (**all savings are net of clinic costs)
WeCare TLC Financial Impact **all savings are net of clinic costs
Making Care Convenient and Accessible
Typically, going to the doctor is inconvenient, stressful and expensive. WeCare TLC strives to make it as easy as possible for employees to get care by offering:
A physician-led model. Although many patients will see a registered nurse or nurse practitioner for some care, many want to have an ongoing relationship with a personal physician.
No co-pays. Even a small co-pay acts as a deterrent to care.
Open appointments for walk-in visits. WeCare TLC purposefully schedules
open appointments each day to handle urgent and emergent care. A dispensary. The top reason patients first come to a clinic is to get their
Convenient and flexible hours: Clinics are open late or on weekends,
and are designed to meet employee needs.
As a result of this approach, WeCare TLC has some of the highest employee participation rates in the industry.
Percentage of Employees Who Use On-site Clinics
Measuring Metrics to Ensure Success
One of the hallmarks of a patient-centered medical home is an ongoing commitment to quality improvement. WeCare TLC analyzes important performance metrics such as:
Patient satisfaction: Patients are surveyed on every visit.
Generic utilization: Frequency of patients’ use of generic medications.
Provider utilization: How often employees use providers at various licen- sure levels: RN, NP or physician. It also assesses the types of clinical services being used.
Evidence-based practices: Providers’ charts are audited continuously to ensure care is complete and follows evidence-based protocols.
Referrals: Referrals to specialists must be timely and appropriate; none should occur for routine office care.
Follow-up care: Frequency that patients receive timely follow-up care.
Study Proves the Value of Employer-Based Medical Homes
On-site clinics tame health care cost trends in two ways: one, by providing similar services at much a lower cost and two, by disrupting the existing model of health care delivery.
When it comes to medications, tests and treatments, WeCare TLC clinics offer these services at a fraction of the market cost. Its providers are salaried and have no incentive to refer patients to specialists or order unnecessary tests. In fact, WeCare TLC clinics have reduced referrals to specialists by 50 percent by providing needed care within its primary care clinics.
Longer-term, the WeCare TLC model improves employee health as many workers who use the clinics previously had no primary care provider. Through care management, nurses also follow employees when they receive care outside the clinic to ensure high- quality, coordinated and cost-effective treatment. Through health coaching programs, healthy employees stay well; those with chronic conditions learn to better take care of themselves, which lowers future health care costs.
WeCare TLC ’s results since inception are promising:
of employees are satisfied with the scope of services
reduction in specialist referrals
of prescriptions filled with generics
Why Medical Risk Management is the Key to Successful On-site Clinic Operations
Employers can find answers to such questions as:
What are the untreated health needs in my employee population, such as diabetes and hypertension?
What is the risk level of each employee?
How many employees are overweight or tobacco users?
When can generic medications be used?
Which community specialists and hospitals should I include in my plan design?
Where am I seeing excessive specialist utilization and should I bring those services in-house?
Employers can respond by taking such actions as:
Promoting the use of generic medications at the on-site dispensary.
Changing clinic hours to ensure maximum employee participation.
Steering employees to certain hospitals or specialists in exchange for lower prices.
Reaching out to individual patients to boost enrollment in disease management programs.
Modifying clinic offerings to bring more encounters in-house.
The patient-centered medical home serves as a platform to deliver primary care services tailored to employees’ unique health risks. WeCare TLC seamlessly pulls together employer health plan and on-site health clinic data, which it then analyzes to identify health care cost savings and quality improvement opportunities.
Using data from medical claims, employees’ health risk appraisal forms, the electronic health record, pharmacy, lab and clinic costs, WeCare TLC’s clinical analysis toolkit reports reveal where employee populations are getting healthier and hidden opportunities for cost-savings.
WeCare TLC’s goal is to identify and manage current and potential employee health issues in a way that mitigates short-term health costs. This helps employers save money on health plan costs, while increasing employees’ long-term health and productivity. This comprehensive approach is called “medical risk management.”
Case Study: Healthier Employees in Just One Year
When WeCare TLC opened a patient- centered medical home to serve a heavy equipment manufacturer in Indiana, many of the company’s 720 employees were suffering from obesity and overweight, high blood pressure and uncontrolled diabetes.
In just one year, employee health improved dramatically:
58 employees – or more than half of the firm’s diabetic employees – had their blood sugar under control.
181 employees – or 42 percent of the overweight and obese workers – lost weight.
64 employees improved their management of high blood pressure.
Using widely accepted measures that tie dollar values to health improve- ments, WeCare TLC estimates the manufacturer saved $404,325 in long-term costs.
How Quickly Can New Clients Save Money?
Changing employee behavior and reversing health cost trends can take time. Actions and inactions from years before can show up as medical emergencies many years later. That’s why WeCare TLC looks at health plan cost data for up to three years prior to opening a clinic. After one year of opening a WeCare TLC medical home, the data team provides employers with a rolling, month-over-month analysis of how their financial trend is changing.
Clients can expect in the first year to see health care cost inflation flatten, as employees increasingly use generic medica- tions and get their primary care needs met at the clinic. In the second year, referrals will decline as employees use specialists less frequently and their health improves as they start to more proactively manage their chronic conditions. In the third year, employees’ chronic conditions improve, leading to reduced prescription medication and health care costs.
“WeCare TLC brings a fresh concept to the practice of medicine. They have the experience of operating clinics that are customized to the client and their need. I believe strongly that WeCare TLC offers the experience, the neutrality, the advocacy an employer needs and the expertise to manage your health care clinic.”
Jim Rubottom, Vice President, Human Resources
The Knapheide Manufacturing Company