Onsite 2.0: Part 5: The New Model
This is the final article in our five-part series, “Onsite Clinics 2.0: The New Model for Employer Sponsored Healthcare.” Now is an exciting time for employers interested in deploying innovative healthcare solutions to address rising costs and chronic disease rates across their employee population.
Employers looking to offer onsite care that serves as a legitimate alternative to traditional primary, urgent, and chronic condition care need to think more broadly about their onsite care models. They must go beyond simply offering a menu of a la carte onsite services that are convenient, but additive or fragmented to traditional delivery outlets, to creating a delivery model that actually replaces the status quo and enhances healthcare service delivery, outcomes and optimizes spending.
Onsite Clinic 2.0 Attributes
- Emphasis on Patient-Physician Relationship
- Enhanced Physician Access
- Comprehensive Scope of Care
- Physician Coordination of Specialist Care
- Convenient Clinic Locations Accessible for Dependents
- Financial Incentive Alignment
- Provider/Employer Partnership
1. Emphasis on Patient-Physician Relationship
The Onsite 2.0 Model is founded on a patient-centered care approach—a method of care delivery designed around what matters most to patients and which routinely collects patient feedback to improve service delivery. Having dedicated providers that can deliver a comprehensive scope of patient care is a departure from the traditional Onsite 1.0 philosophy, and is critical in fostering patient centered care. We recommend that this care be delivered by a physician-led team, as a key tenet of patient centered care is the correlation between a positive patient-physician relationship, treatment outcomes and patient satisfaction. A study performed by the University of Auckland found that higher levels of patient-reported patient-physician concordance were associated with one-third greater medication compliance. Other research confirms that what patients want most from their physicians includes; a personal relationship, strong communication, and empathy.
2. Enhanced Physician Access
Convenient physician access is at the center of a strong patient-physician relationship, but is sorely lacking in most traditional care models, as well as Onsite 1.0 programs where physicians are not at the center of care delivery. Patients need access to a provider or team that can address the broad spectrum of their needs—including primary care, urgent care, and chronic condition management. Inadequate access to an appropriate-level provider wastes an estimated $38 billion annually from unneeded ER visits is according to a New England Health Institute study.
According to a Truven Health study, 24 percent of ER visits are non-emergent and another 42 percent are emergent, but could be treated in a primary care setting if only patients could easily access their physician and their physician had enough time available to handle their patients’ needs holistically.
In the Onsite 2.0 Model, patients have improved methods of accessing their physician virtually, in addition to significantly improved in-person access. For example, best-in-class models provide 24x7 access to a patient’s personal physician (not a telemedicine hotline) in case an urgent issue arises. Additionally, scheduled telephonic visits, secure email or messaging and access to a portal to view medical records, request prescription refills and schedule appointments are also recommended. Mobile optimization to facilitate the above activity is also critical to encourage patient engagement. Providers who are able to deliver this service level typically have considerably smaller patients per provider—for example 800 patients compared with over 2,300 patients for the typical PCP.
3. Comprehensive Scope of Care
A primary goal of the Onsite 2.0 Model is to expand the percentage of overall treatment delivered within the onsite or near-site setting when compared to Onsite 1.0 offerings. In addition to the impact this can have on existing onsite programs, the overall impact of migrating care to the right place by the right provider at the right time can have direct and advantageous impact to an employer’s healthcare claims spend and referral patterns. Across the U.S., the rate of specialist referrals has increased by 94 percent over the past 10 years. Due to time pressures driven by high patient loads, primary care physicians currently delegate nearly 40 percent of primary care services (services they could handle in their offices if they had the time to do so) to higher-cost specialists.
By lowering patient panel sizes, offering convenient onsite and near-site locations with enhanced access for patients, and ensuring high physician clinical expertise is available, physicians practicing in the Onsite 2.0 Model can perform a greater percentage of healthcare services than the current primary care model delivers. In Onsite 2.0, physicians can directly perform the primary care services that are routinely referred out to specialists. This leads to significant cost savings for both employees and employers and adds convenience and care coordination benefits. Onsite 2.0 models typically perform the following broad scope services:
- Primary care
- Preventative care
- Acute care
- Urgent care
- Chronic disease management
- Specialist referral coordination
Additionally, Onsite 2.0 models also typically offer In-house pharmacy and lab services for greater patient convenience and cost savings, although these are not considered physician services.
4. Physician Coordination of Specialist Care
Of course, there are many patient needs that require downstream services such as imaging, or specialist physician care. A key component of the Onsite 2.0 Model is a different approach to the referral process where physicians and their care teams play an active role in selection of downstream care providers and specialists and take the responsibility to coordinate needed downstream care. Unlike physicians in large provider groups who may be incented to refer patients to in-group ancillary services and specialists regardless of cost and outcome track records, Onsite 2.0 physicians should be accountable to guide patients to high-quality, lower-cost services. For example, MRI costs can vary tremendously even within an individual market. A Washington Post exposé revealed pricing ranging from $400 to $2,183 in the D.C. area for a standard MRI on an ankle.
Further, when specialist services are needed, the Onsite 2.0 physician should help select the optimal physician for the patients’ needs and communicate the patient situation in detail prior to the visit as well as partner with the specialist throughout the care episode. This way, Onsite 2.0 physicians and care teams can work closely with specialists to avoid duplication and/or overtreatment and ensure the use of specialist expertise is truly optimized. Lack of care coordination often leads to overtreatment, costing the United States between $158 and $226 billion annually.
5. Convenient Clinic Locations Accessible for Dependents
The saying, “Location, location, location”, is as true for healthcare as it is for real estate. For employees, onsite care is highly convenient during the work day, but often not a viable solution for dependents. The Onsite 2.0 Model typically employs a dual location approach—onsite and near-site clinics. Onsite clinics are typically accessible for employees as they are on or near worksite premises. Near-site clinics are then located in the communities closer to where employees and their families live, so that they are very convenient to the dependent population. Another advantage of near-site clinics is that they can be shared across employers. Often even smaller employers can offer Onsite 2.0 through the utilization of a near-site clinic network.
6. Financial Incentive Alignment
78 percent of employer sponsored health plans, inclusive of Onsite 1.0 programs, are based on the FFS model which is fundamentally at odds with the goals of the care philosophy driving Onsite 2.0 Models.
When employers launch a comprehensive primary care program through the Onsite 2.0 offering they hope to achieve the following goals:
- Improved health outcomes
- High rates of employee satisfaction
- Healthcare cost reductions
- Improved employee productivity
Onsite 2.0 models need an incentive structure that aligns with these objectives. A three-pronged approach works best, for example, Onsite 2.0 physicians are salaried and receive bonuses based on health and care quality outcomes, patient satisfaction and patient engagement.
Onsite 2.0 clinical results are measured in a variety of ways, including comparing the population’s results for receiving recommended preventive care to nationally-recognized benchmarks. Additionally, leveraging electronic health records and other technology tools, Onsite 2.0 models track outcomes-based metrics for chronic disease (e.g. diabetic blood sugar control). By setting standards at, or above, nationally-recognized benchmarks, Onsite 2.0 models strive to deliver superior results in health outcomes both from the perspective of delivering needed preventive care and screenings as well as improving chronic disease management. Ultimately, both can be expected to contribute long-term cost savings.
Patient satisfaction is highly correlated to medical advice compliance. Onsite 2.0 models value and collect patient satisfaction feedback and strive to deliver superior satisfaction results. In a patient-centered care model, patient satisfaction must be part of the program’s culture, and every member of the care team should be focused on the drivers of high satisfaction.
The final aspect of incentive alignment is patient engagement. Onsite 2.0 models that offer reduced patient panels allow their physicians to spend significantly more time with patients than in traditional healthcare settings. They also have the capacity to perform more holistic care and explore comprehensively all aspects of a patient’s physical and mental well-being. Giving physicians the gift of time to spend on their patients without the concern of driving volume creates the right environment to engage patients in improving their overall health. A strong level of engagement between patient and physician has been linked to better compliance with lifestyle recommendations and early detection of potentially dangerous conditions.
7. Provider/Employer Partnership
For Onsite 2.0 models to satisfy all of an employer’s objectives, it is important to maximize the number of employees and dependents who utilize the model. Benefit plan design and employee communications should incent employees and dependents to establish care with this new option. Better access to a high-touch physician relationship, convenience and financial incentives are the factors that drive early employee and dependent adoption of this type of model. Once it has launched, word-of-mouth referrals and ongoing communications help drive rapid expansion.
Over two-thirds of onsite clinics are run by third party operators. Employers looking to select an operator should evaluate in what ways the operator is prepared to partner in terms of incentive alignment and employee recruiting.
As you can see, the Onsite 2.0 Model is not only a vast departure from what has been historically offered in the worksite health space; it is truly a new approach to proactive, accountable healthcare that transforms underutilization of primary care and overutilization of urgent, ER, and specialist care into an optimized setting for all covered lives of a population. The following table outlines the experience differences when considering an Onsite 2.0 strategy versus continuing to utilize the existing primary care system as it exists today.
The Onsite 2.0 Model addresses the root causes of healthcare cost escalation and inferior health outcomes in the U.S., but it is a major philosophical shift. Employers looking to embrace the new model need to educate their employees on the benefits in terms of service, convenience, care and costs. They need to partner with an operator who embraces the model, provides aligned financial incentives, and will invest in delivering and measuring high levels of employee utilization, satisfaction and savings. To learn more, download the full whitepaper.