special report on employer worksite clinics and... · 2019-03-27 · key research findings include:...

© 2018 ARTHUR J. GALLAGHER & CO. | AJG.COM

Special Report on Employer Worksite ClinicsAn Evolving Employer-Based Healthcare Delivery SystemDeveloped by Benfield, a part of the Gallagher Human Resources & Compensation Consulting Practice in partnership with the National Association of Worksite Health Centers (NAWHC)


2

» Introduction » Research Panel» Clinic Offerings and Approach» Clinic Services» Outcomes & ROI» Third Party Clinic Management & Support

Contents

© Benfield, a part of the Gallagher Human Resources & Compensation Consulting Practice. 2018 Worksite Health Clinic Report. All rights reserved.


3

Introduction

The worksite clinic market represents an evolving healthcare delivery channel for primary and specialty care. The National Association of Worksite Health Centers (NAWHC) and Gallagher-Benfield conducted research in 2018 to study this market and increase the ability of employers to benchmark their worksite clinic operations.This report includes findings from an in-depth survey of 109 employers.

Key research findings include:– Adoption & growth of worksite

clinics is expected to continue– High quality care is delivered via

worksite health clinics– Employer approach to clinic

decision making and management varies based on organizational priorities and internal expertise

– Measuring and achieving outcomes is challenging but essential for long-term clinic investment and success

© Benfield, a part of the Gallagher Human Resources & Compensation Consulting Practice. 2018 Worksite Health Clinic Report. All rights reserved.


4

Worksite Clinic Research Panel

Employer Participants by # of U.S. Employees 109 Employer Surveys80 with Worksite Clinics

29 without Worksite Clinics*

5% Hospitality; 5% Public Entity; 4% Business Services; 4% Energy;4% Transportation; 2%Construction; 2% Wholesale; 3% Other

Employer Participants Industry Classification

39%Manufacturing

9%Education

9%Retail

8%Healthcare

6%Finance

n=80 Employers with worksite clinics*Those w/o a clinic were asked about future plans and current barriers

5%9%

8%

23%

16%

20%

8%11%

100-9991,000-2,4992,500-4,9995,000-9,99910,000-19,99920,000-49,99950,000-99,999100,000+

Jumbo Employers (5,000+ EEs)

78%

© Benf ield, a part of the Gallagher Human Resources & Compensation Consulting Practice. 2018 Worksite Health Clinic Report. All rights reserved.


Clinic Offerings and ApproachOnsite and Nearsite


6

Worksite Clinic Models and Characteristics among Surveyed Employers

Onsite clinics are located on an employer’s campus and the services offered typically reflect the needs of that specific location’s population

Nearsite clinics are located in close proximity to an employer providing services to one or multiple organizations in the area

63%Onsite

16%Nearsite

21%Onsite +Nearsite

Some employers provider a combination of onsite and nearsite clinics to service employees at multiple locations

n=80 Employers

Half of employers (51%) with a worksite clinic plan to add an onsite or nearsite clinic within two years.



7

A majority of employers favor multiple clinic locations, regardless of clinic type

Current Nearsite Health Clinics

47%

10%

20%

23%33%

16%21%

14%

16%

Number of Onsite and Nearsite Health Clinics

n=67 Employers

Current Onsite Health Clinics

n=30 Employers

1 Nearsite clinic

2 Nearsite clinics

3-5 Nearsite clinics

10+ Nearsite clinics

1 Onsite clinic

2 Onsite clinics

3-5 Onsite clinics

6-9 Onsite clinics

10+ Onsite clinics

Multiple Clinic

Locations

67%Multiple Clinic

Locations

53%



8

A limited number of employers share their onsite clinic with nearby employers, but 6 in 10 report their nearsite clinic is shared

n=67 Employers with an onsite clinic

Shared Onsite Health Clinics Shared Nearsite Health Clinics

Yes12%

No88%

Yes63%

No37%

n=30 Employers with a nearsite clinic

Shared or multi-employer clinics are open to employees from several employers in an area. They can be onsite or nearsite locations.

Shared Employer Clinic



9

Over one-third of existing clinics are accredited, putting them on par with accredited traditional, community-based providers

36%

64%

Accredited by NCQA, The Joint Commission, URAC or AAAHC

n=80 Employers

Yes

No

What does it mean to be accredited by NCQA, The Joint Commission,

URAC or AAAHC?

For a worksite clinic, accreditation stands as recognition of a legitimate

healthcare facility, practicing at or above the quality of, and with all the

capabilities of a traditional community-based provider with the same

accreditation(s). 43%

35%

27%

Specialized clinic provider(e.g., Premise Health) (n=35)

Run internally by Employer (n=23)

Community health provider(e.g., medical group, IDN) (n=22)

Accreditation Rates by Clinic Management



10

More challenging than costs, employers rate putting systems in place to measure results as the top challenge to opening the clinic

40%

28%

24%

24%

18%

15%

13%

13%

10%

9%

8%

8%

5%

5%

Challenges to Opening a Worksite Clinic(among employers with a worksite health clinic)

n=80 Employers

Putting systems in place to measure results

Costs

Hiring high quality providers

Establishing technology platform

Space

Buy-in from internal decision makers (e.g., C-suite, etc.)

Employee concern over confidentiality of patient information

Selection of a third party clinic provider partner

Equal treatment of employees (can’t offer at all locations)

HSA-based HDHP requirement for enrolled employees to pay fair market value for clinic services

Decision to self-manage the clinic or contract with a third party

Competition with local medical communityWorksite clinic services counted toward

Cadillac tax calculationHealthcare liabilities



11

For employers that have not adopted worksite clinics, cost and lack of C-suite support are major barriers; Execution challenges like hiring providers and measuring results rank far lower vs. those with a clinic

45%

62%

41%

38%

31%

28%

21%

17%

10%

10%

10%

7%

7%

3%

3%

Top Barriers to Worksite Clinic Adoption Among Employers Without a Worksite Health Clinic (percentage indicating a top 3 barrier)

n=29 Employers

CostBuy-in from internal decision

makers (e.g., C-suite, etc.)Space

Beyond the scope of current healthmanagement strategy

Equal treatment of employees (can’t offer at all locations)

Employee concern over confidentiality of patient information Healthcare liabilities

Selection of a third party clinic provider

Hiring high quality providers*HSA-based HDHP requirement for enrolled

employees to pay fair market valuefor clinic services

Competition with local medical community

Putting systems in place to measure results^Decision to self-manage the clinic

or contract with a third partyWorksite clinic services counted

toward Cadillac tax calculation

Of those without a current worksite clinic…

45% plan to adda clinic within 2 years

*Number 3 challenge for those with a worksite clinicN̂umber 1 challenge for those with a worksite clinic



12

Most employers with a worksite clinic have over 1,000 eligible employees at their largest clinic location, two-thirds rely on external parties to run the clinic, and 59% have 3-10+ healthcare providers

9%5%

29%

26%

11%

20% <500500-9991,000-2,4992,500-4,9995,000-9,99910,000+

Characteristics of Employers’ Largest Health Clinics

n=80 Employers

15%

26%

36%

10%

13% <223-56-910+

9%

31%

14%

29%

11%6%

Up to 2 years2-5 years6-9 years10-24 years25-49 years50+ years

# Eligible Company Employees at Location

Years in Operation # of Licensed Healthcare Providers (FTE)

n=80 Employers

n=78 Employers

29%

45%

26%

Party Responsible for Running Largest Clinic

Specialized clinic provider (e.g., Premise Health, QuadMed, etc.)

Community health provider (e.g., hospital,

medical group, Integrated Delivery

Network)

Employer (run internally by company employees)

n=80 Employers

<6 years old40%

> 1,000 employees

86%

3-10+ healthcare providers

59%



13

About half of employers allow spouses, dependents and employees NOT enrolled in the health plan to utilize their worksite clinics

100%

55%

51%

48%

46%

25%

25%

16%

5%

5%

Patient Eligibility for Clinics

*Other includes: All employees no fee (2); Dependents on plan ages 3 and up at one location only; Part-time employees working more than 20 hours

Employees enrolled in our health plan

Spouse/domestic partners

Dependent adult children of employees (18-26 years)

Dependent children of employees(<18 years)

Employees not enrolled in our health plan (same fee schedule as plan enrollees)

Employees not enrolled in our health plan (separate fee schedule)

Retirees

Contract employees

Local community

Other*

n=80 Employers



14

Employers remain in control of strategy, vendor relations and services offered; if applicable, clinic providers are heavily involved in patient care, education and operations

†If clinic is run by third party provider*”Primary” if clinic is run internally by company employees. n=80 Employers

Clinic Decision Making Influence by Stakeholder

C-SuiteVP/Director of

Benefits or Medical Director

EmployerClinic Program Manager

Third Party Clinic Provider

Clinic strategy SECONDARY PRIMARY SECONDARY SECONDARY

Clinic partner relations† PRIMARY SECONDARY

Services offered PRIMARY SECONDARY SECONDARY

Patient care SECONDARY* PRIMARYEmployee/patient and

clinician educational resources

SECONDARY SECONDARY PRIMARY

Day-to-day operations SECONDARY SECONDARY PRIMARY



Clinic Services


16

For many employers, offering worksite clinic services closes a gap for their employees that don’t currently have a primary care provider

n=80 Employers

One in three employers report that>40% of Clinic Patients are Without a

Primary Care Provider



17

One in three respondents have clinics that serve as a patient-centered medical home

A patient-centered medical home is a team-based care delivery model with a primary care emphasis. It focuses on

better access and better care coordination to improve quality, effectiveness, adherence and, ultimately, health outcomes.

27%

3%

14%

52%

4%

n=80 Employers

Our clinic serves as a standalone PCMH

Not currently, but plan to evolve to a PCMH

No, and no plans

Our clinic serves as a primary care extension of a community-based

PCMH

Don’t know

Clinic Considered a Patient-Centered Medical Home (PCMH)



18

The evolution of a broad range of clinic services continues, with large clinics leading the way

88%86%

84%83%

81%76%75%

73%71%70%

68%65%64%

61%60%

53%39%

31%25%

23%18%

15%13%

10%9%9%

8%6%

5%5%

9%11%

9%11%

10%4%

10%15%

10%8%11%

15%25%

15%8%

5%14%

4%14%5%

14%5%

Currently offer (2018) Future (within 2 years)

Services Offered at Largest Clinic Location

n=80 Employers

Health educationPreventive screenings

ImmunizationsAcute/episodic care

Preventive careHealth coaching

Wellness programmingNutrition/weight management counseling

Smoking cessationLaboratory servicesOccupational health

Chronic condition managementPrimary care

Travel medications/travel vaccinationsPrescribing (Rx) healthcare provider

Physical/occupational therapyTelehealth

Behavioral healthMassage therapyImaging services

Specialty medical care (e.g., contracted specialist providers)Vision services

Chiropractic careAcupuncture

Onsite infusionsDental services

Blue services = Top growth areas:

#1 growth area



19

Worksite clinics try hard to connect and integrate services with community-based providers

66%

45%

28%

21%

15%

15%

Communication Channels Established Between Worksite Clinic and Community-Based Healthcare Providers

n=80 Employers

Referral to community providers

Referral system to a clinic-defined network of high quality providers

Integration of electronic medical records

Periodic meetings

Other information sharing

No communication channels in place



20

Half of employers prioritize a core set of services across all of their clinics; Clinic service variation is due to specific location needs and/or use of community health clinic provider

50%

23%

27%

Core Service Offerings Across Clinic Locations(among employers with multiple clinics)

n=52 Employers

We make every attempt to maintain consistency of services offered across all clinic locations

We have core services offered at

all clinics and additional services

vary by location

Clinic services vary by location



21

Over half of employers provide worksite pharmacy services—most commonly by dispensing pre-packaged medications or through a comprehensive pharmacy

19%

25%

4%6%

46%

Worksite Pharmacy Services Offered at Largest Clinic

n=80 Employers

Dispensary pharmacy with pre-packaged medications

Comprehensive pharmacy

None

Concierge pharmacy (personalized medication management services)

Other*

*Other includes: Limited first fill only for some meds (2); Pharmacy management, health coaching; We have a FT Pharmacist for consultee services to members and physicians; We offer onsite pharmacy delivery service

» Comprehensive Pharmacy: In addition to dispensing medications, offers a robust range of services to promote patient health through administration of immunizations, medication adherence programs and chronic condition management

» Dispensary Pharmacy with Pre-packaged Medications: A limited menu of pre-packaged medications (i.e., generics, antibiotics, acute and maintenance medications) are dispensed at smaller clinics or kiosks, typically without requiring a pharmacist

» Concierge Pharmacy: Pharmacist service that focuses on patient support, working in tandem with physician’s office or site of care to provide personalized medication management. This includes consultation on drug interactions, lower cost alternatives, patient assistance programs and lifestyle changes



22

82% of employers offer disease-specific clinic offerings, most commonly around diabetes, smoking cessation, hypertension and obesity

68%61%

56%56%

51%49%48%

45%39%

35%30%30%

25%23%23%

21%20%

18%

Focus of Condition-Specific Clinic Services, Education, Initiatives or Resources

n=80 Employers

Diabetes Smoking Cessation

ObesityHypertension

High Cholesterol Asthma

Back Pain/Other Musculoskeletal Allergy

Cardiovascular Disease Depression

Metabolic Syndrome Women's Health

Pain Chronic Obstructive Pulmonary Disease (COPD)

Insomnia Pneumonia

Substance Use Disorders (incl. Alcohol, Opioids) No condition-specific offerings

<20% provide specific offerings for: Congestive Heart Failure, Migraine, Atopic Dermatitis, Cancer, Crohn's Disease/Ulcerative Colitis, Osteoporosis, Osteoarthritis, Rheumatoid Arthritis, Psoriasis, Hepatitis C, HIV, Hemophilia, Multiple Sclerosis



Outcomes & ROI


24

95% of employers are satisfied with their clinic outcomes, with 39% being very satisfied

39%

56%

5%

Overall Satisfaction with Clinic Outcomes

n=80 Employers

Not satisfied

Moderately satisfied

Very satisfied



25

Clinic utilization is by far the most measured clinic outcome, followed by ROI and use of appropriate preventive care

90%

59%

58%

54%

53%

51%

50%

49%

46%

45%

44%

33%

25%

20%

16%

Outcomes Measured in Organizations' Largest Clinic

n=80 Employers

Clinic utilization

Overall return on investment (ROI)

Use of appropriate preventive care

Immunization rates

Employee satisfaction and retention

Rate of ER visits

Quality of care

Impact on direct healthcare costs

Improvement in health risk assessment results

Health outcomes

Management of chronic conditions

Rx adherence

Reduced absence

Reduced disability

Productivity



26

A majority of employers are integrating their worksite clinic data with health plan data for identification of high risk patients, care coordination and comprehensive outcomes measurement

56%

40%

4%

Integration of Clinic Data with Health Plan Data

n=80 Employers

Yes

No

Don’t know



27

Employers are pleased with outcomes like quality of care and employee satisfaction and retention, but less satisfied with Rx adherence and productivity impact

68%

67%

58%

56%

54%

53%

52%

52%

50%

49%

45%

36%

35%

27%

25%

Quality of care (n=40)

Employee satisfaction and retention (n=42)

Health outcomes (n=36)

Immunization rates (n=43)

Clinic utilization (n=72)

Overall return on investment (ROI) (n=47)

Use of appropriate preventive care (n=46)

Management of chronic conditions (n=35)

Reduced disability (n=16)

Impact on direct healthcare costs (n=39)

Reduced absence (n=20)

Rate of ER visits (n=41)

Improvement in health risk assessment results (n=37)

Rx adherence (n=26)

Productivity (n=20)

Satisfaction with Outcomes Achieved in Organizations' Largest Clinic(high satisfaction among employers measuring outcomes)



28

65% of employers have 40% or more of their eligible employees utilizing their largest clinic site

n=80 Employers

6%

20%

34%

24%

7%9%

<20%20-39%40-59%60-79%80%+Don’t know

Utilization at Largest Clinic Location

≥40% Utilization

65%



29

Employers identify a number of effective measures in driving utilization, including offering services that align with employee needs, reducing the cost and orienting new hires to clinic services

61%

58%

54%

53%

53%

49%

44%

34%

34%

18%

Effectiveness of Driving Clinic Engagement and Utilization

n=80 Employers

Offering services that align with employee needs

Offering free or reduced cost healthcare services

Providing clinic information as partof new employee orientation

Ensuring employees that care is confidential

Testimonials from employees

Communicating quality of providers

Messaging about clinic availability,services and incentives

Incenting employees in a way thatmotivates them to utilize clinic

Offering free or reduced costprescription medications

Offering compelling educationalprograms or resources



Third Party Clinic Management & Support


31

More than 70% of employers outsource management of their largest clinics to specialized clinic providers or community health providers

44%

27%

29%

Party Responsible for Running Largest Clinic

n=80 Employers

Specialized worksite clinic provider (e.g., Premise Health, QuadMed, etc.)

Community health provider (e.g., hospital, medical group, Integrated Delivery Network)

Employer (run internally by company employees)



32

Market share for specialized clinic providers is highly concentrated, with Premise Health responsible for 33% of clinics. Community health providers are more fragmented, but most of them are IDNs

Specialized Worksite Clinic Provider(among employers contracting with a specialized

provider to run at least one clinic)

n=39 Employers

*Other vendors include: Cerner (2); Paladina Health (2); Cigna OnSite Health; Concentra; Corporate Care; InHousePhysicians; Medical Analysis; One to One Health; OnSite Care; SSM Health; Stanford Health Care; SummaCare

33%

13%

8%

8%

5%

36%

Premise Health

QuadMed

CareATC

Marathon Health

Healthstat

Other vendor*

n=22 Employers

Community Health Provider Partners Used:Integrated Delivery Networks (IDNs)» Atrium Health» Banner Health» BellinHealth» Emory Healthcare» Florida Hospital; Integrity Health» Lexington Medical» Ohio State University» Park Nicollet/HealthPartners» Reedsburg Area Medical Center» St. Joseph's/Candler» TriHealth» Unity Point» University of Colorado–Colorado Springs» University of Oklahoma Physicians » University of Pittsburgh Medical Center» Vanderbilt University Medical Center

Other Community Heath Providers» Central Ohio Primary Care» Satellite Med» Other local hospitals and provider groups



33

Factors of highest importance to employers when selecting a clinic partner are the ability to improve population health, closely followed by the ability to hire high quality providers

79%

77%

65%

65%

61%

61%

51%

47%

44%

42%

39%

30%

23%

16%

Importance of Factors in Selecting Clinic Provider Partners(among clinics with a third party clinic provider)

n=57 Employers

Ability to improve population health

Ability to hire high quality providersStrong integration of service with our existing

programs and/or health planData/reporting capabilities

Transparency of cost and performance

Flexibility/ability to customize offerings

Ability to integrate care with community providers

ROI measurement

Price of serviceAccountability, including risk-based payment

contractingCommunication capabilities and marketing

materials to boost utilizationRecommendations from peer companies

Third party organization’s size

Consultant recommendation



34

Health plans, wellbeing vendors, provider groups and PBMs are the top stakeholders providing employers with worksite clinic support

56%

46%

41%

41%

39%

14%

13%

8%

6%

1%

15%

Healthcare Stakeholders that Provided Education, Resources, and/or Tools for Clinics Within the Last Two Years

n=80 Employers

**Other includes: Unknown, this is handled by our vendor

Health plan/TPA

Health & wellbeing vendor

Physician, provider group or health system

Pharmacy Benefits Manager (PBM)

Benefits advisor (employee benefits consultant/broker)

Employer health coalition

Employer interest group (e.g., IBI, NBGH, EBRI)

National Association of Worksite Health Centers (NAWHC)

Biopharmaceutical company

Other**

None of the above



35

Although they’re the top stakeholder providing employers with worksite clinic support, just 4 in 10 employers are highly satisfied with their health plan’s tools and resources

Satisfaction with Education, Resources, and/or Tools Provided by Healthcare Stakeholders (percent very satisfied)

National Association of Worksite Health Centers (NAWHC) (n=6)

Physician, provider group orhealth system (n=33)

Health & wellbeing vendor (n=37)

Health plan/TPA (n=45)

Employer interest group (e.g., IBI,NBGH, EBRI) (n=10)

Pharmacy Benefits Manager(PBM) (n=33)

Benefits advisor (employee benefitsconsultant/broker) (n=31)

Biopharmaceutical company (n=5)

Employer health coalition (n=11)

50%

48%

43%

40%

40%

39%

35%

20%

0%


©2018 ARTHUR J. GALLAGHER & CO. | AJG.COM

Thank You!

© 2018 Benfield, a part of the Gallagher Human Resources & Compensation Consulting Practice. All rights reserved.

SCOTT THOMPSONArea PresidentBenfield, a part of Gallagher Human Resources & Compensation Consulting [email protected]: 630-871-7729

LARRY BORESSExecutive DirectorNational Assoc. of Worksite Health [email protected]: 224-308-6622

mailto:[email protected]

mailto:[email protected]

special report on employer worksite clinics and... · 2019-03-27 · key research findings include:...

Documents