Onsite clinics proving efficient, cost effective and generate higher rates of employee use of health care

Story by Lee Marie Reinsch

If there’s one microscopic thing Republicans and Democrats can agree on these days, it’s probably this: The health-insurance situation in this country is one colossal gut ache for just about everybody. Job creators hate it because it’s obnoxiously expensive, and workers hate knowing that their organ transplants and cancer exams are at the mercy of their fulltime status.

Just what to do about this mutually distasteful state of affairs, nobody seems to have all the answers. So until someone comes up with a halfway workable plan, some employers are taking matters into their own hands – they’re finding that onsite clinics can help them get a grip on costs.

No longer the exclusive domain of huge, top-tier companies like Apple, onsite clinics are becoming more viable for smaller companies, if only because the cost of health care keeps skyrocketing.

Why take on the extra cost?

It might sound counterintuitive to install a company clinic if you’re trying to cut down on overhead. But the logic is that if you catch a leaky pipe now, you might stop the bathroom floor from rotting away and the throne from crashing through the living room ceiling on to your mother-in-law, who is wrapped in her Snuggie catching up on “Cougar Town.”

Like most health care services, an ounce of prevention can cost far less than tons of chronic issues down the road. And the cost doesn’t have to be insurmountable.

“It’s not based on a fee-for-service (basis),” said Jenn Younk, health and wellness sales manager for Prevea Health’s corporate wellness program, LeadWell, in Green Bay. “There’s one hourly rate. That’s made it easier for a lot of smaller companies to join together and share a clinic.”

In other words, if 10 employees see your company’s nurse Monday morning, your company pays by the hour for the nurse’s time rather than for 10 office visits. If the same 10 employees were to go to traditional clinics, you or insurance would pay for 10 office visits.

Health care is the top-ranked expenditure for many employers outside of payroll, yet 40 to 60 percent of employees don’t take advantage of their primary care benefit, Younk said.

“Either they don’t know where to go because they don’t have a regular doctor, or they don’t feel the need to go unless they are sick,” Younk said. “The onsite clinic model offers them a place to go to get their preventive care done as well as other types of things. We can catch so many things when it comes to preventive care – whether it’s getting your blood pressure taken or having a full (blood) lipid panel done, or getting your fasting glucose level measured.”

Before the first phase of the Affordable Care Act took effect last fall, preventive care exams were not covered by many high-deductible insurance plans. That meant patients with such plans had to pay out of pocket for basic exams intended to establish and monitor their basic level of health. Often that means some patients will go years without seeing a doctor, rather than face large out-of-pocket medical bills, which in turn means serious conditions such as diabetes or high blood pressure were allowed to flourish undetected.

Under the new health care law, insurance companies are prohibited from charging copays, co-insurance or deductibles for procedures like colonoscopies, mammograms or well-baby exams.

But even with federally mandated preventive care coverage, getting employees to have little abnormalities looked at before they become more complex medical issues is still a challenge, said Margo Kane, director of human resources for Master Fleet, a Green Bay-based service provider to the trucking industry which just launched a clinic in its facility late last year through the assistance of Prevea.

“In this industry, it’s 95 percent men, and they all think they’re immortal,” said Kane. “Anything we can do to make it convenient for them to go and get something checked out is a win-win all around, and when you split the cost three ways, it really isn’t expensive at all.”

Master Fleet helped make its clinic more efficient by teaming up with two of its customers, Paper Transport Inc. of Green Bay and Marinette-based John Veriha Trucking. Employees from the three companies don’t pay a copayment or deductible to use the onsite clinic, and they don’t have to show an insurance card, Kane said. The clinic itself is open to all employees and their dependents, even those who don’t have employer-sponsored insurance coverage through the company.

“If we can catch one heart issue or one diabetes case, it will pay for itself right away,” said Barb Kornowske, director of human resources for Paper Transport Inc.

Indeed, it did in at least one case. One employee saw the onsite nurse practitioner because he just didn’t feel right. The nurse took his blood pressure and found it to be so high that she made an appointment with the cardiology team.

“They ended up finding out that he had a 99 percent blockage in one artery and a 66 percent blockage in another – he was a walking time bomb,” Younk said. “Had he not had a physical, he probably wouldn’t have seen a doctor until something happened or he was admitted to the emergency room. We probably prevented him from having open heart surgery. He had a couple stents put in and was back at work four days later.”

A less dramatic example is Kornowske’s colleague, who suspected she was coming down with the flu. The clinic’s onsite nurse practitioner determined she had appendicitis. While no surgery is cheap, catching the need for one on time is usually cheaper than one involving a trip to the emergency room.

While the “partnership” clinic at Master Fleet is offsite for Veriha and PTI employees, PTI is only about a mile away from Master Fleet, and although Veriha is based in Marinette, around 80 of its employees live in Green Bay. In addition, Kane pointed out that truckers are mobile and seldom in the home office anyway.

But I don’t want my boss knowing I have…

Patient privacy laws are the same in onsite clinics as they are for any other type of clinic, Kane said.

“When you hit that doorway, it’s no longer Master Fleet at all,” Kane said. “Every HIPAA rule applies; all confidentiality is in place.”

Electronic medical records keep track of procedures and results to tests aren’t duplicated, Younk said.

The interaction between employee and nurse helps to promote health almost as much as the actual medical advice, Kane said.

“You develop a relationship with someone, as opposed to going to a (random) doctor who only sees you for five minutes and sends you out the door with no follow up. Trust builds and (employees) see that (the nurse practitioner) is dedicated,” Kane said. “If she has time, she can go out onto the shop floor and say ‘Hey, I haven’t seen you in a while; let’s get a blood pressure reading on you.’ It’s a very comfortable way for these guys to slide into the health care arena.”

Prevea is one of several health care systems getting in on the business of helping companies develop these types of workplace programs.

“A lot of other health care models have acute care where they treat a sinus infection or take a look in your ear and say ‘Yes, you have an ear infection,’ but our nurse practitioner can prescribe as well as diagnose. That individual can do a full-blown preventative exam,” Younk said. “We have full lab capabilities in these onsite clinics so any type of lab work you get done at the doctor’s office is done at quite a discounted price compared to sending it out. Anything you would do at your primary care physician’s office other than X-rays or imaging all can be done onsite at the employer’s location.”

Show me the money

The first year it had its onsite clinic, J. J. Keller & Associates of Neenah avoided $150,000 in health care costs, said Tim Pingel, director of health and wellness for the provider of safety and regulatory compliance products and services.

The second year, Keller avoided $190,000 in health care costs.

Add to that what J. J. Keller estimates it saved in productivity and paid-time off from employees having to leave work to get their health matters taken care of, and you have more than $550,000 in savings in the first two years of its onsite clinic, according to Pingel’s numbers.

Pingel said he figured on the low end for the amount of paid-time off saved.

“We aren’t right in town – we are a little out in the country, outside of town – so if anybody would have to go see their doctor, more than likely they would be taking a minimum of two hours to a half day of PTO to drive out to the appointment and wait and see their doctor and come back to work,” Pingel said.

Even using a lowball figure of 90 minutes of paid-time off per visit, he estimates $90,000 in PTO saved the first year and $121,000 in PTO saved the second year.

“It is much easier to have it onsite, where they can schedule an appointment for basic care-type things and go downstairs or into the next building for it,” Pingel said.

Prevea’s Younk said onsite clinics work best for self-insured companies with at least 200 employees. Companies that are self-insured pay for a portion of their employees’ medical bills out of a fund contributed to by employees.

“Even those preventive exams that are covered 100 percent, if I am a self-insured company, I am paying for that. If a (preventative care exam) costs $150, the employee may not have to pay for it, but I as an employer am responsible for paying that.”

With an onsite clinic program like LeadWell, the company pays the hourly rate.

Employees not in the habit of getting regular checkups might not have a primary care doctor at all, and can end up in the emergency room after-hours for relatively minor things like sinus infections or earaches. “As the employer (with a self-funded insurance plan), I am paying for that ER visit,” Younk said.

If the employee had visited the nurse onsite at work, the same 15 minutes of medical attention would cost the employer a fraction of the ER bill.

The savings add up quickly.

“It makes more sense for those companies to put a clinic in. They pay X amount of dollars to put in the clinic and pay a lower cost per hour than it is for the employees to go to a local doctor and the employer to write a check,” said Derek Boyce, owner of Interra Health, the Brookfield-based company that manages J. J. Keller & Associates’ onsite clinic.

“You can get a positive return on investment within the first year, and that can outweigh the actual costs of setting up and running the clinic,” Boyce said. “You do have to lay a little money out front, but as long as you have proper utilization of that clinic, you will come out ahead.”

Lee Reinsch writes and edits from Green Bay.