Despite worries about post-Affordable Care Act costs for employers rising, worksite healthcare seems to be a growing trend, according to surveys from both Towers Watson and the National Business Group on Health.
“We found it interesting that there is a lot of support for onsite health centers,” says Allan Khoury, a senior health management consultant for Towers Watson. “Senior managers were satisfied with the concept and they remain satisfied—even a bit more satisfied—as time goes on.”
According to Khoury, about a 30% of companies with more than 1,000 employees have some kind of worksite health care, whether that is defined as a single nurse or a full health center with multiple doctors and nurse-practitioners. More than 50% of respondents in Towers Watson’s recent survey regarding onsite health centers said they currently offer or plan to offer health services to employees’ dependents. In the National Business Group on Health’s August 2012 survey on large employer health plans, 46% of respondents maintained onsite health clinics, and 9% more were considering implementing them.
In Towers Watson’s research, the majority of companies listed enhancing worker productivity as their main reason for establishing a center, with many also citing reduced medical costs as a factor. However, only 47% of employers tracked return on investment for their onsite health services, and the data isn’t bountiful.
Clinics providing primary care can realistically break even on ROI within two to five years, according to a December 2010 study from the Center for Studying Health System Change, while clinics that only provide wellness programs often take a loss within the first few years and only see returns in the fourth or fifth year of the program. Most respondents who tracked ROI in Towers Watson’s survey felt theirs was between 1.25 and 2.
But according to Brian Klepper, principle and chief development officer for WeCare, which runs 26 worksite clinics for about 30 companies, most onsite health centers are not saving more money than they cost. Much of that is due to waste in the medical system, he says. He considers his company to be in the medical management business rather than the primary care business, focused on reducing costs through ensuring that patients only get services that are necessary for them, creating aggressive wellness programs, and using step therapy when prescribing drugs to put patients on the lowest cost drugs that work for them.
“People should be investing in a clinic only if they have a high confidence that they’re going to save more money than they’re going to spend,” he notes. “But what we see is that there’s just an immense amounts of money that employers shouldn’t be spending.”
Especially as mandates related to the Affordable Care Act take effect in 2013, controlling healthcare costs is a high priority for corporate benefits executives, according to the National Business Group survey released Monday.
In the wake of uncertainty over the passage of the ACA and future changes, employers surveyed said they were confident they would still be offering health benefits five years from now, but not 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 costs soared, utilization soared and nothing changed on the provider’s side,” 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 as healthcare 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 markets that never existed before in healthcare.”
Many companies involved in NBGH’s survey were already employing tactics 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 from 65% in 2012. A majority also implemented wellness programs, with 60% currently running wellness programs and 16% considering it for the 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 they provide, according to Khoury, including disease and chronic condition care, wellness coaching, ergonomic assessments and even telemedicine through webcam.