Worksite Primary Care Gains Popularity
Practice Management Feature — October 2014
Tex Med. 2014;110(10):49-53.
By Kara Nuzback
Health care costs rise every year for employers and employees. Worksite wellness clinics are gaining popularity among many large corporations for their potential to lower health care costs and reduce employee absences.
Rather than pay for each employee to visit a separate primary care physician, employers are contracting with medical groups that set up primary care clinics at the workplace.
Travis Bias, DO, recently left his private practice in Pflugerville and began working for Crossover Health, a California-based organization that provides worksite primary care across the country. Through Crossover, Dr. Bias practices at a company in Northwest Austin that asked not to be identified.
Dr. Bias says he performs the same duties as he did at his private practice, including regular screenings and physicals, and he educates patients about staying healthy.
"These are high-performing folks," he said, adding the goal of worksite primary care is to prevent mental stressors from becoming physical ailments.
"It's more focused on education, which is the reason I went into family medicine in the first place," he said.
Dr. Bias says in private practice he often felt rushed, and he was unable to educate patients as much as he would've liked. Now, he says, he sees half the number of patients in a day, and his average appointment time is longer.
According to "Worksite Primary Care Clinics: A Systematic Review," published in the May issue of Population Health Management, employers are paying more than ever for health care. The article cites the aging U.S. workforce and the consequent increased burden of illness as reasons for increased costs. In 2007, 39 percent of the working-age population had at least one chronic condition, up from 35 percent in 2003, the article states.
In 2008, the City of San Antonio contracted with Gonzaba Medical Group, a private practice in San Antonio, to offer all city employees and their dependents access to a private wellness center and primary care clinic. And Toyota offers an on-site primary care center for employees at its plant in San Antonio.
According to the report's authors, worksite clinics allow employers more control over direct medical spending by reducing needless emergency department visits, increasing employees' on-the-job hours, and giving companies the ability to contract with specialty groups willing to exchange discounts for patient volume. The report projects 11-percent to 20-percent growth of worksite health clinics in the United States annually.
"Primary care is a valuable thing. These companies realize the value," Dr. Bias said. "It's great for patients and for the physician."
Dr. Bias says the employees have a less expensive copayment when they choose to see him instead of an outside doctor. The company also uses the money it saves on health care to subsidize other employee wellness services, such as an on-site gym for $8 a month and an on-site acupuncturist and dietitian, which each cost less than $10 a visit.
"That's more incentive for employees to keep themselves healthy," he said.
The Ins and Outs
Dr. Bias says the process of referring patients to a specialist is essentially the same as it was in his private practice.
"We've tried to build a network of specialists with whom we work," he said. "We definitely assist employees more with getting their necessary specialty consultations and referrals scheduled. That's another benefit of coming here."
He hopes to serve as the primary care physician for most of the employees.
"Some of them have an outside primary care physician, and we definitely respect that," he said. "We're in no way trying to disrupt that."
Dr. Bias says he doesn't see Medicare patients, children, or infants in his new role. So far, he says he hasn't personally experienced any downfalls to accepting the position at a worksite.
In addition to saving money for the corporation and its employees, Dr. Bias says his own income is higher. Without giving specific numbers, he says his pay is on the "higher end of average" for a primary care physician.
"The income is much better than it was in private practice," he said. "It's definitely not a pay cut."
Though Dr. Bias works longer hours — 10 hours a day as opposed to eight at his private practice — he says getting to spend more time with fewer patients makes it a worthwhile trade.
Dr. Bias says he is also impressed at what worksite perks can do for employee satisfaction.
"The goal is keeping the employees happy and healthy and decreasing their time away from work," he said. "The morale and the attitude here among the employees are like nothing I have ever experienced."
The Middle Man
Texas law prohibits the corporate practice of medicine, so physicians cannot be directly employed by nonphysician corporations that are in the business of providing medical services. The Texas Medical Association has resources and guidance on physician employment.
Organizations like Crossover Health and HealthSmart, based in Irving, bridge the gap by contracting with corporations to establish worksite clinics and contracting with physicians to act as the primary care physician for the corporations' employees.
HealthSmart offers on-site, employer-sponsored primary care clinics to large and midsize corporations with 1,000 or more employees. Bill Paulk, vice president of operations for HealthSmart, says the company opened its primary care clinic division in 2004.
"I've definitely seen the demand grow," he said.
HealthSmart has primary care clinics for Pharr-San Juan-Alamo Independent School District in San Juan and La Joya Independent School District in Mission. The company has two additional clinics in Irving and Lubbock and one out-of-state clinic in Virginia.
"We're going to take care of 80 to 85 percent of their primary care needs," he said, adding that the physicians care for employees and their dependents.
Client corporations pay a flat monthly fee, plus additional fees for supplies to HealthSmart, which in turn pays the physicians, who work on an annual contract basis.
Mr. Paulk says HealthSmart encourages physicians to renew their yearlong contracts so their clients' employees can continue to see the same doctor year after year.
Brett Perkison, MD, is medical director of the Employee Health and Wellness Program at Texas Children's Hospital in Houston.
The program provides full-service primary care for Texas Children's employees, including exams, physical therapy, lab work, urgent care, and disease management. The wellness program focuses on overall well-being, including weight loss and physical activity.
"We've seen some amazing results," he said.
Dr. Perkison says the comprehensive approach to health and wellness allows the primary care physician to work with physical therapists, fitness instructors, and dietitians to address each patient's individual needs.
"That's a lot more effective than seeing patients in a clinic, giving them some advice, and sending them on their way," he said. "It's almost the equivalent of a small-town physician practice located in the midst of a large metropolis."
Dr. Perkison previously worked for five years at Shell Oil Co., where he practiced occupational medicine and helped the company implement employee wellness programs.
"One of the things I stressed to the management was the association of safety and physical fitness," he said.
Working in an oil refinery is a dangerous job, and an unfit employee is more prone to muscle strains and heat exhaustion, he adds.
Among other wellness programs, he initiated a weight loss challenge at Shell. The employees competed in teams to see which team could lose the most weight in 12 weeks. The incentive was small: The boss agreed to take the winners out to dinner. But Dr. Perkison says the response was tremendous. The employees lost a cumulative 300 pounds in 12 weeks.
"It's a naturally competitive environment out there," he said. "They ate healthy, they changed their dietary habits, and it was good for morale," he said.
For Dr. Perkison, one of the advantages of practicing at a worksite clinic with self-funded medical plans is the ability to provide incentives to employees to take better care of themselves.
He says Texas Children's has nearly 10,000 employees, and about 90 percent of those eligible are in the hospital's medical plan. It's in the organization's best interest to keep its employee population healthy to reduce health care costs and ensure employees thrive at work, he says.
Also, he says communication with patients is easier when you work in the same building. He can observe patients' working conditions firsthand and better accommodate them.
"It provides a lot more integrated care," he said. "A follow-up appointment is very easy for a person to make."
Plus, appointments normally take only an hour, as opposed to the half-day it would likely take to see a physician off-site, he says.
At Texas Children's, Dr. Perkison receives a flat salary. He says the hospital bases his performance incentives on improving patient outcomes and reducing hospital admissions, rather than on productivity alone.
Also, at a worksite clinic, the employer assumes much of the financial risk and administrative work, leaving the physician free to focus solely on the quality of care, rather than patient volume, Dr. Perkison says.
"As a result, I deliver better care," he said. "My incentive is to keep the population healthy."
He says before making the switch to a worksite wellness clinic, physicians should consider to whom they'll be reporting and how much discretion they will have over the clinic's budget and personnel.
It's vital to understand the terms of your contract, Dr. Perkison says. Find out how much productivity plays into your salary. If the worksite expects you to see a high number of patients daily and do administrative work, the job might not be for you, he says.
"If you can find the right arrangement, it can be a very satisfying position," he said. "I think it's an up-and-coming organizational structure."
The Long-Term Payoff
William Baun, wellness officer at MD Anderson Cancer Center in Houston, has nearly 40 years of experience in worksite wellness. He says he started his career at Tenneco, Inc. in 1981.
"We probably had one of the first primary care clinic models integrated into a wellness and employee assistance program," he said.
Mr. Baun says MD Anderson does not have a primary care clinic, but it has an employee health services department that integrates occupational medicine and employee assistance programs. The department partners with employee wellness programs that assist with weight management, stress, and lack of physical activity. It also employs several nurse case managers who oversee workers' compensation cases and short- and long-term disability cases.
The article, "What's the Hard Return on Employee Wellness Programs?" Mr. Baun coauthored for the December 2010 issue of Harvard Business Review, says MD Anderson's integrated health and wellness effort for employees resulted in 80 percent fewer lost workdays from 2001 to 2007.
"Cost savings, calculated by multiplying the reduction in lost workdays by average pay rates, totaled $1.5 million; workers' comp insurance premiums declined by 50 percent," the article states.
Mr. Baun says he expects to see more worksite wellness clinics for large companies and for several smaller companies located in the same building. He says the key to a successful worksite clinic is trust.
"Without trust, these clinics have trouble because of confidentiality issues that can plague all wellness programs if employees become concerned that human resources will use this data to terminate sick employees or stressed-out employees," he said.
Mr. Baun says accessibility and convenience are also vital to a worksite clinic's success. He says if a clinic operates only during employees' work time and the employees have no extra time to visit the clinic, it will likely shut down.
"As I look at the clinics that have opened, I think they have had a mixed review. Some do really well, and others end up closing because of lack of engagement from employees," he said.
Kara Nuzback can be reached by telephone at (800) 880-1300, ext. 1393, or (512) 370-1393; by fax at (512) 370-1629; or by email.
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