By Guy Boulton Milwaukee Journal Sentinel.
James Sheeran, director of corporate benefits for MillerCoors, has lost count of the number of people who have toured the company's worksite health clinic in Milwaukee over the past year.
"Interest in on-site clinics" he said, "is exploding."
Employers large and small increasingly see the clinics as an integral part of initiatives to encourage employees and family members to live healthier lives, and help control health care costs.
The clinics, staffed by physicians, nurse practitioners, physician assistants and often physical therapists, provide primary care and other services to employees and their families.
That's benefited companies such as QuadMed, a subsidiary of printing company Quad/Graphics, that staff and run the clinics. QuadMed, one of the pioneers in the business and an outgrowth of a clinic opened by the company in 1991, operates 90 clinics in 18 states.
In Wisconsin, employers with worksite clinics include Northwestern Mutual, Kohl's, Lands' End, WPS Health Insurance, Kwik Trip, Colony Brands, Miniature Precision Components, the Nordic Group of Cos. and the West Bend School District, and that's far from a complete list.
An estimated 29 percent of employers with 5,000 or more employees had worksite clinics last year, up from 24 percent in 2013, according to a recent survey by Mercer, a benefits consulting company.
Last year, MillerCoors' clinic, next to its fitness center, had about 2,600 patient visits for primary care, 1,900 visits for physical therapy and 2,200 ancillary visits, such as getting a blood-pressure test. The clinic employs 10 people, including a full-time physician, a full-time physical therapist and a part-time physician assistant.
"We think it's been quite effective in slowing the rise in health care costs," said Sheeran. "We are very confident of that." The company, which employs about 1,500 people in Milwaukee, uses three measures to gauge the return on the clinic's cost:
-Hard dollars, the cost of providing care at the clinic compared with the cost at similar settings in the community.
-Savings from avoided costs, such as emergency department visits or an employee's losing part of the day for a doctor's appointment.
-Long-term savings from managing chronic diseases, such as diabetes or high blood pressure.
The clinic also is convenient for employees and can result in better care. Appointments, for instance, are scheduled for a minimum of 20 minutes. And employees and their families can build a relationship with a physician.
"That's important to us," Sheeran said.
A GROWING SUBSIDIARY The MillerCoors clinic is run by QuadMed, a business that emerged from a clinic that Quad/Graphics opened almost 25 years ago.
The subsidiary employs about 750 people, including roughly 160 physicians, nurse practitioners and physician assistants, said Sue Buettner, president of QuadMed and a former senior vice president of Aurora Health Care.
In 2013, QuadMed almost doubled in size when it bought Novia CareClinics LLC, which ran 50 clinics and other sites in Indiana and four other states.
The typical clinic has two or three clinicians plus support staff, though its larger clinics can have five or six physicians, and its largest has about a dozen, Buettner said. Roughly half of the clinics have a physical therapist.
The potential savings vary by employer, she said, and depend on the workforce and services.
The savings also can be hard to track because they can come from avoiding costs, such as fewer referrals to specialists or the lost productivity when an employee loses a good part of the day for a doctor's appointment.
QuadMed and other companies typically are paid for their costs plus a management fee.
QuadMed's competitors include Premise Health, which operates more than 500 worksite clinics, and Healthstat, which operates more than 300 clinics. Other competitors include Marathon Health, CareHere and Activate Healthcare.
Some companies focus on smaller employers, typically those with fewer than 500 workers. They include Novia, the company bought by QuadMed, and Sensia Wellness, based in Milwaukee.
Sensia operates seven worksite clinics, said Andrew Seter, a physician and chief executive of the company. The clinics are staffed by a nurse practitioner or physician assistant and are open part of the week.
Sensia can set up a clinic for $10,000. And Seter expects more employers to recognize the advantages.
"This is going to become more of the norm," he said.
NEAR-SITE CLINICS Clinics shared by several employers, so-called near-site clinics, also are becoming more common.
Waukesha County, the City of Waukesha and the School District of Waukesha, Waukesha is a Milwaukee suburb, opened a clinic last year for employees, their families and retirees. And the West Bend School District, also in the Milwaukee area, has a clinic now in its third year.
That clinic, at the school district's central office, is open 30 hours a week and staffed by a physician assistant. It also is an integral part of the school district's health plans and wellness program.
The district offers three health plans, with individual deductibles ranging from $1,000 to $3,000, paired with a health reimbursement account. It will put money into the account to offset part of the deductible provided an employee and family members have a health risk assessment done and visit the clinic at least once.
Someone with a medical condition, such as high blood pressure or high cholesterol, may be required to visit the clinic four times a year to receive the full contribution to his or her health reimbursement account.
The goal is for the employee or family member to build a relationship with the physician assistant, said Valley Elliehausen, chief operating officer of the West Bend School District.
About 70 percent of the physician assistant's time is spent on wellness and the balance on providing basic primary care. There is no copay for the clinic, or for lab tests and prescription drugs from the clinic's limited pharmacy, for people covered by the school district's health plans.
A visit to the clinic costs $129 on average, including lab work and prescriptions, compared with an average of $226 in the community for just an office visit, Elliehausen said. But the real savings are expected to come from helping some employees and family members change their behavior and live healthier lives.
WELLNESS INITIATIVES Supporting wellness initiatives accounts for much of the interest in worksite clinics, said David Keyt, a principal at Mercer. Among the employers participating in the recent Mercer survey, 58 percent said the clinics have succeeded in helping employees control chronic medical conditions.
One potential complication is that the cost of the clinics will be included when determining whether an employer's health plan is subject to the excise tax on high-cost health plans under the Affordable Care Act. The tax will apply to the cost above a set threshold, $10,200 for an individual plan and $27,500 for a family plan in 2018.
Worksite clinics could add some complexity to calculating the value of a health plan, said Charlie Stevens, a lawyer with Michael Best & Friedrich.
It also has added some uncertainty because the IRS has not issued final rules.
"What they have said so far is they are looking at a value for on-site clinics, but they aren't clear on how to do that," Stevens said.
That's not a major concern for Northwestern Mutual. For one thing, its clinics lower the cost of its health plans.
The company's two Milwaukee-area clinics, both expanded since opening, had almost 20,000 patient visits last year. Todd Smasal, who oversees compensation and benefits for the insurance company, described the clinics as a core part of its wellness program and initiatives to control costs.
Those initiatives apparently have had some success: The cost of Northwestern Mutual's health benefits has increased 2.6 percent a year on average for the past five years, well below national averages.
"The on-site medical centers are an important component of delivering those results," Smasal said. "It's not the only thing we are doing, but it's a part."