On a marathon to open clinics

Dr. Jeff Wells runs a company called Marathon Health, but these days, the operation looks almost like a sprint.

While some traditional health care systems are scrambling to retain nurses, therapists and other workers during the pandemic. Marathon Health has hired hundreds of workers during the past 18 months, including 80 last month alone.

The company, which splits its headquarters between Indianapolis and suburban Burlington. Vermont, operates primary-care clinics for employers in 42 states. It offers a wide range of services employees can use for free or at low cost, from annual checkups and health coaching to follow-up care for chronic conditions from diabetes to heart problems.

Business has been booming, as employers from Tyson Foods to Wyndham Destinations have signed up in hopes of keeping workers healthy and lowering health care costs.

What the pandemic highlighted. Wells said, is that employers need to focus on the health and safety of their workers to keep their business operating.

"We actually had our biggest growth year ever through COVID. because the demand for access was so great," said Wells, an internal medicine physician and former Medicaid director under Gov. Mitch Daniels.

During the last year and a half. Wells said, the top line has grown about 20%, although the privately owned company declined to disclose revenue figures.

And Marathon Health continues to pour on the speed. Last week, it announced an expansion of one of its newer product lines, stand-alone clinics in retail areas, into seven new markets, from Atlanta to Phoenix, although it already operates on-site clinics for companies in some of those markets.

It is also adding clinics in cities where it already operates, including Indianapolis. Las Vegas and Orlando, taking the total number of clinics to about 265.

It's a moment for Marathon Health, one of the fastest-growing companies in a burgeoning sector of health care known as employer-sponsored primary care.

Across the United States, large companies are increasingly opening on-site and nearby medical clinics for employees as a way to control health care spending.

Marathon Health claims it helps clients cut health care costs $2,000 per employee per year. That's even though patients visit the clinics 3.5 times a year on average for coaching, vaccines, checkups and other needs.

Those frequent visits mean employees are watching their health and managing conditions before they get serious. Wells said.

But some observers are skeptical about savings on a national basis, saying few deep studies have been done on the issue-including whether the clinics are used mostly by people with high or low health risks.

"I think employer-sponsored primary care is an under-researched issue," said Nicolas Terry, executive director of the Hall Center for Law and Health at the Indiana University Robert H. McKinney School of Law. 'There is some research suggesting cost savings for employers," but it doesn't detail what kinds of patients tend to use the services.

Increasing demand

There's little question, however, that more and more companies are turning to employer-sponsored primary care models. In 2021. more than 60% of companies with 5.000 or more employees offered general medical worksite clinics, up from 47% in 2016. according to a survey by the Business Group on Health. By 2023. the group expects that number to rise to 72%.

And a majority of them are outsourcing those services to a third-party clinic operator such as Marathon Health.

"Since many of these companies are not in the health care industry, and have no desire to take a stab at it ... the market has opened for health systems and startups that manage the clinics for employers," according to a June report in Modern Healthcare, a trade journal.

On a recent day. Brad Duncan, a com-

mercial lender with Centier Bank downtown, stopped at the Marathon Health clinic at Trader's Point shopping plaza on West 86th Street to get a biometric screening (a combination of blood pressure, body mass index, and a blood draw to measure blood sugar and cholesterol) that his company offers as a savings incentive on the health insurance plan.

Duncan, who lives about 15 minutes away in Brownsburg. said the clinic was a convenient way to handle the screening before he headed to work.

"I was in and out in five minutes," he said.

In another examination room at the Trader's Point clinic. Matt Blanford was getting ready for his physical. Blanford. who also lives in Brownsburg. has been in the network about a year, and hadn't seen a doctor in several years, since his previous physician retired.

*i am that horrible person that stays away from doctors as much as possible," Blanford said. "But when my wife added this as a benefit for us. it was pretty nice."

The airy, modern clinic, spanning about 3,500 feet with six examination rooms and 10 employees, sits between a mattress store and a nail salon in the busy shopping center, with heavy foot traffic at almost all hours of the day.

Even so. the clinic is not open to the general public but is meant to be a convenient place for workers of Marathon Health clients around Indianapolis to use.

Convenient access

The company opened the site in 2014. one of seven free-standing clinics employees from any client can use. Similar Marathon Health clinics are in Fishers. Washington Square. Plainfield, Greenwood and downtown. The latest one opened in July on the ground floor of The Olivia in Carmel, an upscale apartment complex.

Together, they provide a network of clinics used by tens of thousands of people who work for companies that have hired Marathon Health to help manage their primary-care needs. The goal is to have workers no farther than 10 miles from where they live, work or shop to see a primary-care doctor or nurse.

If patients need a higher level of care- to see a specialist or to get an operation- a Marathon Health doctor or nurse practitioner refers them to an outside provider.

In addition to the free-standing clinics. Marathon Health runs clinics inside the campuses of some of its larger clients, which include health insurer Anthem Inc. downtown, vehicle remarketing company KAR Global in Carmel. and the Indianapolis Airport Authority.

Employers pay Marathon Health a fixed fee for the services, ranging from S50 to $60 per employee per month.

Marathon Health said it uses the money to hire doctors, nurses, therapists, coaches and other health care providers, along with office staff, to make sure its patients are keeping healthy or managing chronic conditions as well as possible.

"We don't get paid for the number of visits that we do, or the number of transactions, or the number of referrals that we make, or the number of lab tests that we order." Wells said. "We get paid a fixed fee, and then we put that fee at risk tied to outcomes. ... So we want to have a really deep, meaningful engagement with our patients."

Formerly OurHealth

If the name Marathon Health doesn't ring a loud bell, that's because the company was called OurHealth for most of its lifetime in Indiana.

Wells founded OurHealth in 2009 with partner Ben Evans, a former commercial real estate broker. The two met through a mutual friend who knew Evans was trying to get a health care venture off the ground and might be able to use the insights of Wells, a physician who ran Indiana's Medicaid program.

"I just sort of saw. from my experience, how inefficient and sort of messed up the health care delivery system really was." Wells said. "It wasn't working very well for anybody-not for patients, certainly not for payers of health care employers, but not even for the providers or the health care professionals working within the system."

Evans said he was impressed with Wells' entrepreneurial mindset and medical background.

"We met and really quickly, we kind of realized we worked well together." Evans said. "And he joined me to start the company."

Evans served as CEO the first 10 years, as the company landed a series of large customers, including the city of Indianapolis. One America and Ice Miller LLP. OurHealth gradually expanded operations beyond Indiana into Illinois. Ohio, North Carolina, Pennsylvania and Tennessee, growing to about 300 employees. The clinics operated under the MyClinic brand.

After a decade of going on their own. Wells and Evans concluded they had a proven model of helping employ-cos stay healthy and helping companies save money.

"So then the question became, how big is this opportunity to really make an impact across the country?" Wells said.

Joining forces

The two decided the opportunity was huge, but they would need more money to grow on a national scale. They talked to investors and other executives, and eventually met the leadership team at Marathon Health, a 15-year-old operator of employer-sponsored primary care clinics with about 700 employees and operations from Nevada to Florida.

After months of discussion, the two leadership teams decided their companies shared the same philosophy of helping employees stay healthy and saving money for employers.

They also decided having a larger national footprint put them in a better position to make investments in technology, real estate and employees. They found a financial partner. General Atlantic, a growth equity firm based in New York City, which made an undisclosed investment in the combined companies.

In January 2020. about two months before the pandemic, the two companies announced the merger, saying each operation would keep its name for the time being.

That eventually changed, when the two decided the Marathon Health name had greater national recognition.

A Marathon Health executive in Vermont. Jerry Ford, became CEO of the combined companies at the start. After he retired this March, Wells took over as CEO. Evans is now chief growth and strategy officer.

"So I spend most of my time thinking about, 'What does this business look like in two to three years?'" said Evans, who is a son of Daniel Evans, retired CEO of Indiana University Health. "And where's the puck going?'

The answer, he said, is that patients increasingly want a choice of how health care is delivered-at the workplace, or in retail settings, or online. (Like many clinics around the country, Marathon Health has seen its telemedicine use skyrocket during the pandemic.)

Beyond that, Evans said, the company has to "drive fantastic access to care and delight the patient through their experience."

"Of course, it's been challenging," Wells added, "and our teams have been stretched and stressed. But I think under the circumstances, our culture's actually allowed us to sort of weather the pandemic better than a lot of organizations would.

"And I think we're kind of coming together and strengthening and arc super excited about the future."*

So I spend most of my time thinking about, 'What does this business look like in two to three years?'

Ben Evans, Marathon Health chief growth and strategy officer