Onsite 2.0: Part 3: 7 Reasons to Reinvent the Current Onsite Clinic Model
This is the third in our five-part series, “Onsite Clinics 2.0: The New Model for Employer Sponsored Healthcare.” In the previous article, we looked at the changing role of employer-sponsored clinics. This segment explores the limitations in the Onsite 1.0 Model that must be overcome to address root cause healthcare cost and quality issues.
While the results of onsite health clinics are generally positive, there are a number of limitations to the predominant Onsite 1.0 Model that limit the impact this model can have on employee participation, and the quality of the healthcare available and the impact to overall healthcare claims costs for all covered lives on the health benefits plan:
1. Onsite access limited to employees
Most workplaces are secured, making entry difficult for family members. For this reason and historical precedence, the majority of onsite clinics today are not open to dependents. This limits the health and cost impact an onsite solution can have to at least half of most total covered populations on a company’s insurance plan.
2. Only viable for largest employers
Although changing, there is still a mindset amongst employers that they must be a very large employer to support an onsite clinic solution or that onsite clinics are only applicable to manufacturing companies. This limits the pool of companies evaluating this solution significantly.
3. Staffing Model/Quality Perceptions
Traditional Onsite 1.0 clinics may have performed routine preventive care and first aid. A major paradigm shift is required for employees to perceive onsite clinics as qualified providers of high quality, comprehensive health care services and be willing to switch from current primary care providers. The fact that the majority of 1.0 clinics are staffed with nurses or nurse practitioners vs. physicians have made them less appealing and less appropriate for employees to migrate from their current primary care providers despite the lower out-of-pocket costs afforded by onsite care.
4. Lack of Expertise to Manage Chronic Conditions
Employees and their dependents with chronic health conditions account for a disproportionate share of healthcare spending. This is precisely the population that employers are targeting in their overall healthcare strategy. Aligning the service offering at an Onsite 2.0 clinic with this need is imperative to address the costliest individuals and 1.0 programs typically cannot address chronic condition management in a sophisticated way. Without trained physicians on site with systems designed to support population health management, patients with chronic conditions cannot be systematically treated and improved health outcomes cannot be measured.
5. Employee Privacy Concerns
Healthcare is a private matter and many employees have concerns that health information uncovered at onsite clinics will be made available to their employers. This is particularly prevalent when the providers are employed by the employer. Others are concerned that being seen in the onsite clinic will raise flags about their health status.
6. Separate Worker’s Compensation Return-to-Work Programs and Primary Care
The best primary care physician relationships are founded on trust. The more the provider can establish a positive patient-physician connection, the better the outcome will be in terms of utilization of primary and preventive care services and medical advice compliance. Return-to-work decisions and, occupational medicine services in general, by the onsite provider can significantly jeopardize the patient-physician relationship. For this reason, primary care and occupational medicine services are best managed separately.
7. Cost Center Mentality
For onsite clinics to play a larger primary care role, they need to be developed using financial structures that drive net cost savings for the employer’s overall health plan expenditures over time. Since most onsite programs have been established as cost centers, without value-based payment structures, they are not able to effectively drive or measure ROI.
If employers want to maximize the benefits of their onsite health clinics in terms of engagement of all covered lives (not just employees), health outcomes, overall healthcare cost reductions, and productivity improvements, they need to eliminate the limitations that today create distinct barriers to widespread adoption and utilization of this more accessible and convenient primary care option. Onsite clinics are evolving to address issues of access, incentive alignment, scope of services, and payment structure to deliver on the goals that employers, plans, unions, and benefits consultants are seeking in their healthcare strategies.
Next in our series, “Onsite Clinics 2.0: The New Model for Employer Sponsored Healthcare,” we will explore the recent explosion in the number of onsite clinics and see that they are no longer restricted to manufacturing giants. To learn more, download the whitepaper.