_{Jonathan Spero, MD, InHouse Physicians, December 7, 2011}

A recent survey from Mercer found that work site centers are becoming an increasingly popular way to control health care spending and even enhance employee productivity.
 
Until recently, work site centers were largely popular only at Fortune 500 companies, however, the trend is now spreading to local governments and mid-size companies of 250 or more employees.
 
Generally, the care received at the center is free to the member and there is an added convenience factor for employees.  Work site centers to date have primarily experienced their return on investment for the employer by providing more efficient care at the worksite center rather than paying claims from community physicians.  However, the next generation of centers are in the process of being rolled out and offers a more compelling value proposition and much greater associated health care savings.
 
The following are key concepts of this next generation of worksite centers and how they will drive significant reductions in health care costs for employers.

Concept #1

• At Risk Model

Worksite vendors are more increasingly willing to deliver these services with some portion of the compensation being at risk. The greater the savings to the employer, the greater the potential bonus for the vendor. In this model both the client and vendor have incentives that are congruent.

How these vendors are measuring savings or return on investment varies.  The most accurate way to determine the saving generated from the on-site center is to compare the annual cost of health care (pmpy) for members eligible to use the center (“study group”) vs. members who are not eligible to use the center (“control group”).  This provides the employer with a direct comparison of the two groups’ costs and a direct measurement of the savings.

Concept #2

• Gaps In Care Analysis

Before the center even is launched, the employer benefits from powerful analytic software tools that can filter through the previous year’s claims data to determine gaps in care for 
 
individuals and identify “high risk” members that require additional intervention.  These high-risk members can be invited to visit the center and enroll in on-site programs designed to ensure quality care and improved outcomes.

Concept #3

• Patient Centered Medical Home

The clinicians at the worksite center can build a medical home model program.  The medical home model understands that chronic diseases require input from multiple providers and specialists and are often difficult to manage for providers as well as the patient.  The worksite clinician can act as a coordinator of care ensuring quality, cost effective, evidence based medicine is delivered.  In addition to educating the patient on their condition, the “coordinator” communicates to all physicians involved in the care of the patient.  This program acts as a very effective disease management program with member engagement levels routinely above 80 percent.  The worksite center enrolls members who are at high risk based on the analysis of gaps in care mentioned above.  Common diseases that are coordinated include diabetes, heart disease, asthma, arthritis, and chronic pain.

Concept #4

• Clinical Engineering

Traditionally employers have relied solely on the carriers to negotiate agreements with providers.  However, these agreements are not necessarily in the best interest of the employer or the patient.  Not only can more favorable pricing be negotiated from quality providers but also, the agreements have no quality guarantees associated with them.  Worksite vendors have a unique opportunity to identify high cost procedures and hospitalizations and negotiate case rates directly with providers and hospitals with built in quality performance guarantees.  Significant savings for employers and members as well as improved patient outcomes are the results of these arrangements.

Concept #5

• Price Transparency and Patient Advocacy

Worksite clinicians, now armed with comprehensive pricing and quality metrics, can effectively act as patient advocates assisting members with making informed medial decisions.  Patients, with the assistance of the worksite center, can comfortably choose a cost saving option for a diagnostic or clinical procedure knowing that they are receiving quality health care for the right price.

Concept #6

• Predictive Modeling

Worksite centers have the ability to attach current member health risks to future costs allowing the centers to develop targeted wellness programs that zero in on future cost drivers.  In addition, the center can provide useful health care budget estimates to the employer’s benefits department when planning for next year.

Concept #7

• Telemedicine

The worksite center is often not available for remote employees and dependents.  Telemedicine, quickly becoming a mainstream method of care delivery, can address this issue.  Telemedicine, via telephonic and two way video communication, can allow patients to receive medical evaluation and treatment.  Not only can this be offered to members that do not have access to the on-site center, but also members with access to the center have a resource for after hours care.

Concept #8

• Wellness 

The center offers year round, on-site, integrated wellness programs that cannot only drive participation, but are very effective in modifying healthy lifestyle behaviors amongst members.  Clinicians are being cross-trained as certified health coaches and up to 15% of the visits to the center are being utilized as purely health coaching sessions.
 
In summary, employers are looking for employee health solutions that offer a one-stop shop for effective health care cost containment.  The next generation of worksite centers promises to offer just this.  The on-site center builds trust and relationships with members, which facilitates engagement in wellness, disease management, and patient advocacy programs driving improved outcomes and lower costs.

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