On-site clinics deliver benefits [Albuquerque Journal, N.M.]

March 26--Lisa Martinez is a human resources training specialist at Isleta Pueblo'sHard Rock Hotel and Casino south of Albuquerque.

Earlier this year at work she developed a cough and a headache. She walked down the hall to the Rock-In Clinic where she saw Dale Walaszek, a physician assistant employed by ABQ Health Partners. Martinez was examined, treated and was back at her desk in a matter of minutes.

About a month earlier, Martinez came down with flu. She was diagnosed at the Rock-In Clinic, got a prescription that she filled on her way home, and was soon in bed resting and recovering.

Absent the Rock-In Clinic, cases like these would involve perhaps an hour of travel time to an off-site urgent care center and back again, plus two to three hours of waiting at the center to be seen. An emergency room visit would consume six hours or more. Martinez has a primary care physician, but the earliest appointment she could get to be seen for her flu symptoms was two months away.

Business owners and managers have long understood that healthy employees are productive employees, and that profits follow productivity. The challenge is keeping employees healthy affordably and efficiently. Intel Corp., Hard Rock and the Don Chalmers car dealerships are finding the best way to do it is by providing health care on company property. Intel built an on-site clinic last year that it staffs and operates itself. Hard Rock and Chalmers contract with Lovelace Health Plan to obtain the service.

Just good business

Yolanda Ramirez, assistant human resources manager at Hard Rock, said the two-year-old clinic helps keep employees at the work site. "If someone has to leave for medical reasons, the majority of that employee's shift is lost," Ramirez said. "That has an impact on staffing levels."

On-site medical expertise also helps Hard Rock improve employee health through education, wellness and fitness programs and health assessments. "All of that has contributed to a new awareness of healthy behavior," Ramirez said.

Clinic practitioners are able to identify contagions before they get out of hand and have even saved employees' lives. "That alone was worth the investment," Ramirez said.

Hard Rock employs 1,200 people. Walaszek said he sees from five to seven people during his shift on a normal day and as many as 18 during flu season. He is one of six providers at the Rock-In Clinic. The average wait to be seen is five to 10 minutes. Treatment takes from 15 to 20 minutes.

Rhonda Bentz, a nurse practitioner, sees patients at Don Chalmers Ford in Rio Rancho and at Chalmers Ford Lincoln Mercury in Santa Fe.

"I find myself doing basic medical care, somewhat like urgent care," Bentz said. "I draw blood, examine patients, write prescriptions. I refer the patient if I think they're dealing with something that is beyond my scope or that will turn into a chronic problem." Both of the clinics deal with a lot of sore throats, skin problems, minor infections, colds and flus.

Financial incentive

"Don Chalmers always said that if running a car dealership was a democracy, then Rhonda would be president and CEO because she's the most loved person in the dealership," said Kirk Meyer, chief financial officer.

"Most of our employees' pay is based on commission," Meyer said. "If they have to take time away to go to the doctor's, that's two, three four hours. That's money out of their pockets."

Chalmers makes money too. "I get statistics from Lovelace, and I compare my per-patient, per-month cost (against other employers)," Meyer said. "I know my costs are lower than the average cost of other participants in the Lovelace Health Plan."

Bentz, like her colleagues at Hard Rock, also leads on-site wellness efforts. The most recent push has been to reduce overweight employees' waists two sizes. That effort, if successful, will lower medical costs at Chalmers and for Lovelace, said Linda Reiter, Lovelace Health Plan assistant vice president for outcomes medical management. Medical literature shows medical and absenteeism costs increase $917 per year per employee when the employee is 30 to 60 pounds overweight.

An employee who quits smoking saves the employer $1,000 in the first year he quits, $2,000 in the second year, and $2,400 a year thereafter, she said.

Those behavior changes can be pushed and tracked through the on-site clinics.

Helping the bottom line

"There are some statistics that say of the total cost to the employer of poor health, 24 percent is medical cost and disability," Reiter said. "The other 76 percent is the cost of presenteeism, absenteeism, having to replace an employee with a short-term worker." Presenteeism occurs when a sick employee continues to work but at a lower level of productivity and effectiveness.

For Lovelace, lower medical costs mean better profits for the plan and lower premiums for employers, which translates into more success competing for insurance business.

Reiter said Lovelace Health Plan hopes to get more businesses to install on-site clinics. Reiter said it costs about $25,000 to $30,000 to equip a clinic. Remodeling a space for the clinic at the work site is extra. Lovelace negotiates with the employer over who will pay which expenses.

Ramirez said that Hard Rock provided the remodeled space and Lovelace provided the equipment and contracted with ABQ Health Partners for the clinic's staff.

"We're making a new move this year and focusing harder on chronic conditions," Reiter said. Providers at the clinics will work to identify and counsel employees with conditions such as diabetes and who are at risk for heart disease and stroke.

The cost will be $24 per member per month, but out-of-control diabetes costs $115 per member per month, Reiter said. "We want to drive our quality and we want to drive the value we provide to our employer groups," she said. "We want to make sure the wellness message becomes a generational change."

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