Employers Turning To On-Site Clinics In The Workplace

March 19--Nearly a third of Metropolitan Nashville Public Schools teachers rely on the district's on-site clinics for their primary care.

At Southern Farm Bureau Life Insurance Co. in Jackson, Mississippi, 85 percent of the actuaries, underwriters and other employees say the company's on-site clinic providers are their primary care physicians.

With an estimated 30 percent of the nation's employers, including public and private examples in Memphis, now operating clinics at or near job sites for their employees, workplaces that are also medical homes for employees and their families are a trend to watch in health care.

"I think in the near future, and when I say near I'd say within seven to 10 years, most of primary care will be outside of the doctor's office," said Larry Boress, executive director of the Chicago-based National Association of Worksite Health Centers.

The NAWHC and three other employer health care-focused organizations -- the Memphis Business Group on Health, Mississippi Business Group on Health and Knoxville-based HealthCare 21 Business Coalition -- sponsored a regional workshop in Memphis last week on the value of on-site and near-site clinics.

FedEx, Hollywood Casino, Nissan and Trustmark Bank, as well as Metro Schools and Southern Farm Bureau, were among employers sharing clinic experiences.

Far from being left behind, health care providers are supporting the growth.

In Memphis, for example, Methodist Le Bonheur Healthcare OnSite operates a clinic for the city of Memphis at 1803 Union, two for Shelby County Schools on Flicker in Midtown and off U.S. 64 in Lakeland, three for International Paper and one each for Hollywood Casino and Electrolux, Methodist officials said.

"I would say almost every one of our members either has an on-site clinic or is thinking about it," said Cristie Upshaw Travis, chief executive of the Memphis Business Group on Health.

Boress listed several companies such as Premise Health, Marathon Health and Cerner supplying worksite clinic services, with electronic medical records as a core component to help ensure that workplace care is linked to doctors' offices and other providers.

"On-site shouldn't be another fragmentation of health care," he said. "It should be an extension."

In Nashville, Metro Schools started its clinics in 2009, remodeled five portable classrooms and hired nurse practitioners to provide care, said David Hines, director of employee benefit services. The district contracts with Vanderbilt Health for its clinics.

Chiefly funded from the teachers' health plan, the clinics serve a population of about 6,200 active employees and 3,000 retirees, Hines said. Including dependents, the group grows to more than 17,000 people.

"We are at a point now, after six years of operations with our nurse practitioners, and it is very much a medical home-centered model that we have pursued, that we have about 30 percent of our active employees' primary care being basically provided by our clinics," Hines said. "By investing more in primary care, we've been able to control more costs downstream."

Health indicators have improved and costs have decreased, with $2.4 million saved in 2014, the most recent year available, he said.

The savings are reinvested in the on-site approach. A new brick-and-mortar clinic including physical therapy, chiropractic, pharmacy, health coaching and behavioral counseling services, as well as exercise space, is scheduled to open in January.

At Southern Farm Bureau, where an on-site clinic started in 2009, health costs decreased 18 percent last year for the large majority of employees who are neither real healthy nor real sick, said Matt Ginn, manager of corporate communications and training.

Still, the company's overall health costs for about 650 employees, and about 1,100 people in all, rose about 4 percent because of a couple of high-cost health claims, Ginn said.

Providing on-site care with nurse practitioners and doctors, including laboratory services, and funneling through the clinic incentive programs is worthwhile, he said. Employees can save $30 a month in premium costs, he said, spend more time at work, and avoid unnecessary and expensive hospital and emergency room use.

"It's really a big health promotion tool to encourage families to live a healthier lifestyle," Ginn said.

Boress, also chief executive of the Chicago-based Midwest Business Group on Health, said that 40 to 60 percent of those who go to on-site and near-site health centers don't have doctors. They are now getting care at work, and with connections with local doctors, hospitals, pharmacies and other providers, can get continuity of care, he said.

About 60 percent of employers don't charge co-pays or deductibles at the centers and drugs may be free, although by law employees with health spending accounts must be charged something, removing a barrier for those with low incomes or high deductible plans, he said.

With multiple kinds of wellness programs as well as fitness centers in the workplace, the clinics can be the hub in the wheel, integrating fragmented services for employees.

Boress counted down key reasons that employers with as few as 100 employees are considering on-site health care:

"To keep people on the job, to reduce the cost, to give people greater access, to improve their health and to be an employer of choice."

They range from 50,000-square-foot facilities to a clinic serving multiple employers in an industrial park. And there is telehealth that allows conversations with doctors or nurses by smartphone; mobile vans that offer medical, dental and other services, or a "physician concierge" who comes to a workplace when called.

"I would say the message would be don't be scared off if you think it's too costly," Boress said. "It's worth having a conversation."

___

(c)2016 The Commercial Appeal (Memphis, Tenn.)

Visit The Commercial Appeal (Memphis, Tenn.) at www.commercialappeal.com

Distributed by Tribune Content Agency, LLC.