Despite worries about post-Affordable Care Act costs foremployers rising, worksite healthcare seems to be a growing trend,according to surveys from both TowersWatson and the NationalBusiness Group on Health.

“We found it interesting that there is a lot of support foronsite health centers,” says Allan Khoury, a senior healthmanagement consultant for Towers Watson. “Senior managers weresatisfied with the concept and they remain satisfied—even a bitmore satisfied—as time goes on.”

According to Khoury, about a 30% of companies with more than1,000 employees have some kind of worksite health care, whetherthat is defined as a single nurse or a full health center withmultiple doctors and nurse-practitioners. More than 50% ofrespondents in Towers Watson's recent survey regarding onsitehealth centers said they currently offer or plan to offer healthservices to employees' dependents. In the National Business Groupon Health's August 2012 survey on large employer health plans, 46%of respondents maintained onsite health clinics, and 9% more wereconsidering implementing them.

In Towers Watson's research, the majority of companies listedenhancing worker productivity as their main reason for establishinga center, with many also citing reduced medical costs as a factor.However, only 47% of employers tracked return on investment fortheir onsite health services, and the data isn't bountiful.

Clinics providing primary care can realistically break even onROI within two to five years, according to a December 2010 studyfrom the Center for Studying Health System Change, while clinicsthat only provide wellness programs often take a loss within thefirst few years and only see returns in the fourth or fifth year ofthe program. Most respondents who tracked ROI in Towers Watson'ssurvey felt theirs was between 1.25 and 2.

But according to Brian Klepper, principle and chief developmentofficer for WeCare, which runs 26 worksite clinics for about 30companies, most onsite health centers are not saving more moneythan they cost. Much of that is due to waste in the medical system,he says. He considers his company to be in the medical managementbusiness rather than the primary care business, focused on reducingcosts through ensuring that patients only get services that arenecessary for them, creating aggressive wellness programs, andusing step therapy when prescribing drugs to put patients on thelowest cost drugs that work for them.

“People should be investing in a clinic only if they have a highconfidence that they're going to save more money than they're goingto spend,” he notes. “But what we see is that there's just animmense amounts of money that employers shouldn't be spending.”

Especially as mandates related to the Affordable Care Act take effect in 2013, controllinghealthcare costs is a high priority for corporate benefitsexecutives, according to the National Business Group surveyreleased Monday.

In the wake of uncertainty over the passage of the ACA andfuture changes, employers surveyed said they were confident theywould still be offering health benefits five years from now, butnot confident about a decade from now, according to Helen Darling,the group's president and CEO.

“What happened [in the managed care era] was we found that costssoared, utilization soared and nothing changed on the provider'sside,” Darling said in a press conference on the NBGH's findings.“We've come full circle again.”

Another incarnation of managed care may become more popular ashealthcare costs continue to rise—NBGH's respondents plan on a 7%median cost increase in 2013. “The interesting thing about this[is]we are right at [the] very infancy of industry,” Klepper says.“It's a paradigm shift. What it's doing is it is creating marketsthat never existed before in healthcare.”

Many companies involved in NBGH's survey were already employingtactics like WeCare's, though not all were using onsite clinics.Step therapy also was a priority for them to reduce costs: 73%planned to use it in 2013 to manage their pharmacy benefit, up from65% in 2012. A majority also implemented wellness programs, with60% currently running wellness programs and 16% considering it forthe future. Most – 79% – offer price transparency tools online,allowing patients to see what they're paying for.

Worksite health clinics also are expanding the kind of care theyprovide, according to Khoury, including disease and chroniccondition care, wellness coaching, ergonomic assessments and eventelemedicine through webcam.