Clinics and Employee Benefits and Health Care Reform and Health Care & Life Sciences and Wellness

On-site health care clinics moving beyond traditional settings

September 11, 2010

When Dr. Jeff Wells stepped down as director of the Indiana Medicaid program, he could have used his MD and MBA degrees to do a lot of things. But he decided to co-found a startup venture called OurHealth that puts small health clinics in employer offices.

These on-site clinics, as they’re called, also attracted Peter Dunn after he ended his tenure as CEO of Steak n Shake. He co-founded a company called Activate Healthcare LLC, which is seeking to put clinics in employers’ offices.

What caught the attention of Wells and Dunn is that on-site clinics are showing signs of breaking out of their niche among blue collar and government employers—factories, warehouses and school corporations—and could pop up in Class A office buildings filled with white collar workers.

“It started a couple years ago as being a fad. I think what it has turned into is that more and more employers are facing double-digit increases” in health care costs, said Spencer Milus, who recently joined Indianapolis-based First Person Benefit Advisors to help employers add on-site health and wellness options for their workers. “They need to take more control.”

National researchers are detecting the same thing. Massachusetts-based Fuld & Co. predicted last year that the number of on-site clinics at employers would more than triple by 2015.

Wells’ company opened its first clinic Sept. 9 at the headquarters of Interactive Intelligence Inc. The Indianapolis-based software will pay OurHealth a monthly fee for the 1,000-square-foot clinic, which will offer doctor visits and generic medications free to Interactive’s 475 headquarters employees.

The Interactive clinic is a perk to employees. But it’s also an attempt to head off chronic diseases, such as diabetes, before they become a big concern for employees—and a big cost to Interactive, which self-funds its health insurance plan.

“With the focus we have on wellness, the clinic will also provide health assessments and hopefully detect those hidden health care risks earlier,” said Debra Jones, Interactive’s director of human resources. She said the clinic idea was suggested to interactive by its benefits broker, Joe Perkins of Indianapolis-based MJ Insurance.

Interactive’s health plan costs have risen by high-single digits in recent years—consistent with national and state averages—and the company is not expecting the clinic to save it money, at least in the short term. But because the clinic will provide services and medications the company had paid more for elsewhere, the company also doesn’t expect to see an increase.

“We’re going into this providing a benefit for our employees, providing a different model for accessing health care, and really a better model,” Jones said.

No reason to rush

That model is different in how it handles time. The typical family doctor tries to pack in as many patients as possible into one day—because insurance plans pay relatively low amounts for primary care office visits. The result is familiar: A patient frequently waits a long time to see the doctor and then gets roughly 10 minutes of the doctor’s time.

At Interactive’s headquarters near West 79th Street and Interstate 465, employees get an e-mail from the clinic a few minutes before their appointment, reminding them to walk to the company’s first-floor clinic.

The doctor staffing the clinic is paid a flat fee by OurHealth no matter how many patients he sees. So if he decides he needs to spend extra time with a patient, he’s not losing money to do so.

The idea is to give doctors more time to zero in on patients’ underlying problems and coach them about how to manage them, said Wells, who is president of OurHealth.

“The model that we’re trying to set up is very different from a traditional delivery model,” Wells said. “I do see it as transformational, not just a novelty.”

Wells, however, presses the point that OurHealth’s clinics can save employers money. Instead of having their employees pay retail prices for prescription drugs, lab tests, etc., the clinic allows them to buy those products and services at wholesale rates, which are about 30 percent cheaper.

On top of that, Wells is convinced that having a clinic on site will reduce employee absences for medical visits and “presenteeism,” where workers use company time to handle health issues or work at reduced efficiency because they’re struggling with an untreated illness.

“There’s real value in realigning and redesigning the way primary care is delivered,” he said. OurHealth expects to open two more on-site clinics by year’s end.

Activate Healthcare does not appear to have opened any clinics yet. Dunn could not be reached for comment for this story. However, he told The Wall Street Journal last year that he ended up founding Activate Healthcare as an opportunity to “solve unsolved problems.”

Rivals jump in

Activate Health and OurHealth, which Wells founded with local real estate entrepreneur Ben Evans, are the new kids on the block in on-site clinics.

Indianapolis-based Novia CareClinics LLC started in 2006 and has installed clinics for 24 employers, including Sheridan-based Biddle Precision Components, the town of Fishers, and Brownsburg Community Schools Corp. It now works in partnership with the St. Vincent hospital system.

Community Health Network has been active providing on-site clinics at such employers as Keihin IPT in Greenfield and Celadon Trucking Group Inc. in Indianapolis. Its on-site clinic business, now branded Infinity, grew out of offering occupational health services to employers.

The Clarian Health hospital system went through the same transition, and now is offering on-site clinics to employers under its subsidiary Workplace Health Services.

All are putting new effort behind the old idea of on-site clinics. They have been common for decades at the largest employers, mainly as a way to help injured employees get back on the job quickly and conveniently.

Eli Lilly and Co. operates multiple on-site clinics at its headquarters in Indianapolis, and has for more than 20 years.

The trouble is that most employers don’t have enough workers—or not enough workers in one place—to justify the costs of having an on-site clinic.

Wells sees potential in smaller employers banding together to open a shared clinic in their offices. Whether OurHealth can be successful getting companies to cooperate remains to be seen.

But there are other options for smaller employers.

Irwin R. Rose & Co. decided it could not do an on-site clinic because just 15 of its 180 workers are at its home office. The rest oversee Rose’s apartment complexes in Illinois, Iowa and Texas.

So it eventually hired Community’s Infinity program to provide a health coach who is available by telephone. The coach will meet all Rose employees next month at an all-company meeting in Texas, so they know who she is when she calls.

Jamie Gray, Rose’s chief financial officer, said he hopes the certified health coach is better trained to help his employees who smoke or who are suffering from or at risk of developing diabetes or obesity than the disease management programs he has tried before.

For example, he said, someone may be overweight due more to stress than to lack of knowledge about diet and exercise. But he said the personnel at disease management companies often lacked the skills to zero in on such underlying causes and provide employees help.

“A health coach is better prepared, I guess, to discuss many types of risk factors and many types of disease,” Gray said. “They’re better trained overall to deal with many of the risk factors and many of the things in our life that we deal with on a day-to-day basis.”·

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