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On-site clinics
Large employers are increasingly turning to workplace-based care to control health-care costs and to better serve their employees.
Services typically offered include:
•Routine screenings for glucose monitoring, blood pressure checks, cholesterol levels.
•Wellness exams
•Diagnosis and treatment of non-life threatening illnesses, injuries and infections
•Lab tests
•Routine physical exams
•Wellness evaluations and coaching
•Generic medication
Cathie Rowand | The Journal Gazette
Teacher Laura McCoy, working out at the Central Branch YMCA, has benefited from the wellness program offered by FWCS’s employee health clinic.

Clinical approach to WELLNESS

Employer-based care improves access, health and bottom line

Michelle Davies | The Journal Gazette
Nursing assistant Bernadette Andrews works at Allen County’s employee health clinic, a pioneering initiative credited with limiting costs.
Dorko
Peters
Ferguson

Music teacher Laura McCoy wasn’t happy with changes in Fort Wayne Community Schools’ health insurance program. The district’s decision to set up employee health clinics looked as though it might prevent her from seeing her own family doctor.

But interest in making healthy lifestyle changes prompted McCoy to take advantage of personalized wellness coaching offered through the two clinics. Six months later and 50 pounds lighter, she’s sold on the value of the FWCS Health and Wellness Centers.

“It’s a real benefit,” McCoy said. “There are lots of appointment times. It’s much more convenient. There’s no co-pay, ever. It’s a nice, secondary approach to health care.”

It’s more than that. The growing popularity of workplace-based clinics promises to be a key to controlling health-care costs nationwide. By encouraging patient responsibility and addressing risks or conditions early, clinic care can reduce or even eliminate the need for costly hospital care.

In McCoy’s case, she was able to keep her family doctor, while the emphasis on wellness and prevention at the Catalpa Street clinic transformed her approach to eating and stress management and helped her find the proper balance for good health. Convenient access and the emphasis on wellness and prevention supported changes she likely wouldn’t have maintained otherwise, the 35-year veteran teacher said.

Major employers, public-sector officials and health-care professionals increasingly see the value in employer-based programs. Access to primary care is the key, according to Steve Ferguson, board chairman for the Cook Group, parent company of Bloomington-based Cook Medical. The federal health-care debate and Affordable Care Act that emerged from it wrongly addressed the issue of how to pay for care and not how to deliver it, he said. His company’s two decades of experience with an employee clinic support Ferguson’s argument.

Growing popularity

Employer-based clinics might sound like a familiar feature from days past. Manufacturers often had medical staff on site to address workplace injuries or illness – Fort Wayne’s General Motors truck assembly plant has a medical department for that purpose.

But workplace clinics are different. Cook Medical began its Cook Family Health Center 20 years ago when company officials found employees couldn’t get in to see primary care physicians in Bloomington and were visiting the emergency room and urgent care centers instead. By setting up its own clinic and hiring staff, the company could establish a gateway to primary care, Ferguson said.

Cook was a pioneer in the area, but it now has lots of company. Allen County government contracted with the Fort Wayne Medical Education Program to open a clinic in 2007. Commissioner Nelson Peters said he believed it became the first local-government unit in the state to do so, earning recognition from the Association of Indiana Counties for its innovative and cost-effective approach.

Southwest Allen County Schools adopted the model in early 2011, partnering with Lutheran Health Network to open an employee clinic on its freshman campus at Homestead High School.

Fort Wayne Community Schools contracted with Indianapolis-based NoviaCare Clinics to open its clinics last year, and Northwest Allen County Schools, in partnership with Parkview Health System, opened a clinic at the Carroll Freshman Academy. East Allen County Schools’ new walk-in clinics, also in partnership with Parkview, opened just this month.

The employer-based clinics are tailored to individual needs. Allen County’s employee clinic is at Citizens Square, while FWCS has a clinic on the northeast side of Fort Wayne and a second on the southwest, so as best to accommodate employees at schools citywide.

There’s some variation in services and payment requirements as well. Jim Gardner, president of the Cook Family Health Center, said the Bloomington clinic maintains a high physician-to-patient ratio to ensure ready access to care. It also has a full-service pharmacy. Employees and their dependents pay $15 for an office visit.

But the center also keeps overhead low.

“Billing is very simple,” Gardner said. “We don’t have all of those administrative challenges that a more typical health-care setting has. It really focuses on patient care.”

That’s another advantage: Less physician time spent on insurance coding and billing means more time for patients and, ultimately, better health outcomes.

Controlling costs

Joe Dorko, CEO of Lutheran Health Network, sees the employer-based care issue from a macro-economic standpoint. Health-care spending held at about 18 percent of the U.S. gross domestic product between 2010 and 2011, he said, but the high percentage of overhead attributed to health care is a hindrance to U.S. companies in terms of global competitiveness. That affects the U.S. economy overall, Dorko noted.

“The focus we have as a network is to keep costs down,” he said. “We need to improve clinical outcomes, improve the experience and to do it for less than we did in the past.”

Employer-based clinics help do that by increasing access to primary care. Hospitals are the most expensive setting for delivering services, Dorko said. Forward-thinking employers are turning to clinics because they are a benefit to employees and because more accessible, efficient care means less time away from work.

Lutheran, obviously, doesn’t need to set up stand-alone clinics, because its employees already have access to physicians. The network’s emphasis, instead, is on the wellness and prevention services that employer-based clinics are offering.

“Right now we are working with employees who are diabetics,” Dorko said. “It’s much cheaper to put you on diabetic medication than to amputate a foot.”

Lutheran is also working with employers like Sweetwater Sound. While it doesn’t have an on-site clinic, the company is offering financial incentives to its employees to meet with wellness coaches and focus on preventive care.

Experience shows the new efforts create savings.

“What we’ve found is our costs have not increased as fast as everyone else’s,” said Cook Group’s Ferguson. “As I recall from when we started, our costs were higher than (Indiana University’s) costs. If you look at it now, our costs are less than IU’s.”

Cook, the nation’s largest privately owned medical-device maker, has a self-funded health insurance program. About 5,800 employees and family members are covered by its clinic plan. Peters said Allen County government was able to cut its annual health-care bill from $12 million to $9 million for several years, but catastrophic claims pushed costs higher in the past couple of years.

“I would like to think that, in part, it was the clinic and some of the pre-emptive care,” he said. “If you look at the trend line and what is happening overall, while you’ve seen double-digit increases elsewhere, our trend is only about 8 percent this year. Although it wasn’t the panacea, it was part of the solution.”

Peters wants to drive costs down by increasing the use of the county’s clinic. He has tried to bring city government in as a partner.

“We’re back at the table,” he said. “I’ve said we’ll participate in the (city’s 311 caller assistance) program if they will join. It’s self-serving, but if I can get 100 percent utilization of the clinic, we can drive the per-office visit cost down by $20.”

The commissioner also wants to better market the service to county employees and to reach out to other downtown employers.

Less easy to calculate are savings the employer-based programs create from reduced absenteeism, improved productivity and reduced workers’ compensation claims. There’s also no way to quantify employee satisfaction.

Lutheran’s Dorko notes that employers are offering them because they are popular with employees and they become another way to attract talent. He said his son, a Sweetwater Sound employee, is benefiting from wellness rewards.

“He receives $50 every two weeks,” Dorko said. “He doesn’t smoke, he meets with his health coach – he told me, ‘(Sweetwater President Chuck Surack) is paying me to stay healthy.’ That’s smart.”

Cook’s Ferguson said access to the clinic is the most popular benefit for employees,” he said.

“My secretary is about to retire – she told me one of the things she’ll miss most is access to the clinic,” he said.

In the new FWCS clinics, employees and their dependents made more than 6,100 visits in the first year of operation. Teacher Laura McCoy said the wellness services were especially welcome in education because teachers are under great stress.

The Society for Human Resource Management reports that just 8 percent of employers nationwide operate on-site clinics, but the proportion among large employers is much higher. The National Business Group on Health found that 46 percent of large employers now offer the clinics in 2012, a 37 percent increase in just one year.

If politicians didn’t craft a flawless solution to the nation’s health-care problems, the increasing availability of workplace-based care suggests that employers – both private-sector and public-sector – have discovered a way not only to control costs but also to encourage their employees to become healthier.

Karen Francisco has been an Indiana journalist since 1982 and an editorial writer at The Journal Gazette since 2000. She can be reached at 260-461-8206 or by email, kfrancisco@jg.net.

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