© 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)
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» 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.
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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.
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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%
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Clinic Offerings and ApproachOnsite and Nearsite
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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.
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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%
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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
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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
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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
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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
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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%
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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
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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
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Clinic Services
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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
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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)
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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
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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
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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
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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
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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
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Outcomes & ROI
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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
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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
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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
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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)
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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%
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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
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Third Party Clinic Management & Support
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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)
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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
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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
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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
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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%
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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