Worksite Clinics: The Fourth Wave

Written by: Phillip Berry

Worksite clinics have evolved dramatically from their industrial era roots when an onsite nurses helped manage safety programs and onsite injuries. As employers have come to realize the strategic necessity of proactively addressing employee health and associated costs, employer onsite and nearsite clinics have dramatically grown in quantity and capability from those humble roots.

The First Wave

The first wave of onsite clinics introduced acute care to the employees in a basic clinic. Typically staffed by a Nurse Practitioner or Physician Assistant, these clinics focused on addressing basic ailments to help employees get back to work faster. Access to immediate care was convenient and typically saved the employee 2 to 4 hours of time relative to going offsite to an urgent care. First wave clinics might offer basic ancillary services like labs, basic medical supplies, acute medications, and vaccinations to supplement the patient visit. Some would extend the offering with biometric screenings. The value proposition of these clinics focused on access, visit cost savings, less expensive meds, and convenience.

The Second Wave

Employers implementing worksite clinics quickly recognized that their value was directly proportional to how much they were utilized by employees. The second wave for worksite clinics centered on driving utilization. Acute services were expanded to include primary care. Onsite medication formularies grew to address maintenance meds and encompass ninety day fills. Wellness services were added or expanded to provide more robust programs to incentivize better health choices. Some worksites began to offer additional services like physical therapy and health coaching. As the utilization of the onsite or nearsite clinic increased, the value proposition shifted more broadly to include greater cost savings and began to focus on outcomes.

Second wave clinics opened the employer’s eyes to the potential of the onsite clinic. Employees now saw the clinic as a true benefit as convenient access to no-charge medications, longer visits with the practitioner, better health information, and the perception of care by the employer became part of the clinic value story. These clinics could demonstrate a greater return on investment and made it clear that the employer was not completely helpless in the face of continually increasing health care costs.

The Third Wage

For worksite clinic managers, the success of the onsite model created some new challenges.  As the onsite clinics began to have more impact, employers demanded greater value. The new question became: what have you done for lately? Pressure emerged to produce better results across broader health conditions and move toward impacting the greatest portion of the healthcare spend. Employers wanted more. In addition, higher utilization in the onsite clinic created more demands on clinic staff. A key downside of a highly utilized clinic was that medical providers were spending more and more time managing onsite medications and the dispensing process.

Third wave clinics have shifted to new models to bring greater value to employers and their employees. To address the expanding demands of onsite medication management, third wave worksite clinics began to offer a home delivery option for the refill of maintenance prescriptions. Working to broaden services to impact more of the employer’s health spend, chronic disease management programs were added to the clinic’s service set.  Weight management and nutritional services were added to help drive healthier lifestyle habits.  Behavioral health services were added to address the growing problem of anxiety and depression. Third wave clinics began to take a more holistic approach to employee health in an effort to bring greater value.

Also added in the third wave were analytics tools to create a more complete population health approach and help the worksite demonstrate its impact on the overall health spend. With more sophistication and focus, employers were able to rationalize their investment in their employees’ health with measured returns of $3 to $6 for every dollar spent. Additionally, direct savings on prescriptions ranged from 10% to 60% depending on formulary and plan. The worksite clinic had become a key factor in fending off larger annual health cost increases and a key drive of employee satisfaction.

Most current worksite clinics are operating in some version of the the third wave.

The Fourth Wave and Beyond

Today’s worksite clinics have come a long way. With some onsite clinics now operating past their tenth year, they have become a staple in the employer’s health cost defense kit. However, the question remains: what have you done for me lately? Fourth wave clinic functionality has started to emerge. The worksite clinic is becoming a nexus for employee health and its role in quarterbacking employee care across a very wide spectrum will only increase. Here are some fourth wave trends to watch:

  • Broader medication management. The worksite is in a unique position to impact more of an employer’s drug spend. Look for high impact Rx programs to emerge that address high cost brands and specialty medications. The onsite clinic will be able to facilitate an employer’s entire spend by bringing PBM-like services that manage eligibility, claims adjudication, therapeutic interchange, patient advocacy, and medication therapy management. Remote pharmacy will become an option in some states and compliance packaging will also be a part of the service mix.
  • Telemedicine is beginning to appear as an extension of the onsite clinic. Watch for the trend to continue as employers look for ways to help an employee base increasingly spread across diverse locations.
  • Direct contracting and narrow networks are emerging as employers skip health plans and go directly to health systems to secure more complex medical services for their patients.
  • Medical tourism is another direction some employers are taking to help their employees find less expensive options for procedures.
  • Expanding care coordination by the worksite clinic as it continues to broaden its position as a health and financial fiduciary for the employer. Patient advocacy will take on a new meaning as the clinic works to help the patient navigate the complexities of the broader health system.
  • Actionable insights is the name of today’s game in analytics. Where will it go tomorrow? A major issue today is actually having the time to research the insights and take action on them. This applies at the patient and the population level. Massive amounts of data are only making it more difficult to discern the realities as payers obfuscate the details and employers work to peel the layers back. Look for tools that continue to remove the fog of war and simpler models that make costs clear. The worksite clinic will become much better at making those insights actionable in meaningful ways and helping employers sort through the noise.

Of course, much of this remains unwritten. The future is being built rapidly and persistently. Though much of it is reactive, there are intentional innovations being developed to help change a system riddled with inefficiencies, bad players, and grabbing hands. Employers are aggressively pursuing better answers and groups who can help them find those answers will prosper in the next wave.

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