HomeMy WebLinkAboutOn Site Employee ClinicTO: BOARD OF COMMISSIONERS
FROM: DAVE INBODY
SUBJECT: ON-SITE EMPLOYEE HEALTH CLINIC
DATE: 6/24/2010
CC: DAVE KANNER, ERIK KROPP
Background on Clinics
Historically, on-site clinics were located in manufacturing facilities. The clinics would provide
occupational medical services such as treating injuries from workplace accidents, educating employees how
to prevent on-the-job injuries and administering employment physicals and drug tests. The focus was on
returning a worker back to work by treating acute injuries and handling workers’ compensation claims.
Employees would still use their own doctor for routine treatment and care.
In recent years, there has been a resurgence of on-site clinics. Employers, especially those self-insured, are
establishing on-site clinics primarily as a means to address rising healthcare costs. In 2008, a Bucks
Consultants survey of 447 large U.S. employers entitled Working Well: A Global Survey of Health
Promotion and Workplace Wellness Strategies found that 25% of respondents offer on-site medical care.
An additional 11% plan to begin offering on-site services in the next three years. The Convenient Care
Association estimated there were about 1,060 convenient care clinics operating at the end of 2008, up from
about 800 at the end o f 2007. Some large private employers with on-site health clinics include Lowe’s,
Goldman Sachs, Continental Airlines, Toyota, Qualcomm, Harrah’s Entertainment, Florida Power & Light,
Ford Motor Company, Capital One, Random House Publishing and Horizon Blue Cross and Blue Shield of
New Jersey.
Unlike on-site clinics of the past, these new clinics offer expanded services including immunizations,
preventive screenings, acute care, disease management, examinations and pharmaceutical dispensaries.
They are designed not only to address work-related health issues, but also to provide primary care services,
urgent care, wellness programs and preventive care to employees and their dependents. Additionally, most
clinics offer these services at no cost or a discount from traditional care. The following chart indicates some
of the services provided in new and established clinics.
Services % of New
Clinics
% of Est’d
Clinics
Immunizations 81% 91%
Screenings 78% 88%
Urgent Care 63% 75%
Mental Health/EAP 18% 22%
Pharmacy Services 44% 23%
Based on a survey conducted by Watson Wyatt Worldwide
For employees, on-site clinics are convenient, offer quality care at low cost or no cost, and provide more
time with a healthcare provider. According to a survey conducted by Hewitt Associates of 248 large and
midsized companies, 81% of employees expressed satisfaction with results from worksite clinics.
Employees also expressed 95% satisfaction with their on-site pharmacies.
Employers see cost savings from an on-site clinic when their employees avoid using higher cost and more
time-consuming care settings such as traditional primary care facilities, emergency rooms and urgent care
centers. Some employers have also found the existence of an on-site clinic as a powerful employee
recruiting and retention tool. A long-term benefit of an on-site clinic is the ability to pro-actively identify
and manage health risks and chronic disease conditions through the clinic. Since the providers have a
captive group of patients, they can become more familiar with and focus on health needs specific to
employees. By focusing on more lifestyle oriented health issues, such as nutrition, obesity, high blood
pressure, high cholesterol and exercise employees can be healthier and less prone to chronic issues that
represent a significant portion of healthcare costs, such as diabetes and heart disease. An attention to
preventive heath through the clinic identifies conditions that might otherwise go undiagnosed. Early
detection and treatment ultimately reduces long-term healthcare costs. In Montgomery County, Alabama, a
health risk assessment was offered at their on-site clinic. Out of approximately 800 employees, 117
employees were diagnosed with diabetes and a pre-diabetes condition, 56 with hypertension and seven with
early signs of prostate cancer. None of these conditions had been previously diagnosed.
Deschutes County’s Interest in Clinics
In 2005, the Public Health Department conducted preliminary research into various methods for providing
discount prescription drugs to their clients. One consideration was the establishment of an on-site
pharmacy. This did not come to fruition, but communication between with the Health Benefits Coordinator
regarding this research led to their attending a webinar in October 2008 addressing on-site clinics. After the
webinar, the concept of an onsite employee health clinic was introduced to County administration.
In the fall of 2009, County Administration began to research on-site clinics that included contacting more
than 20 city and county governments across the country operating on-site clinics. Nearly all of the
contacted jurisdictions reported significant savings on healthcare costs with clinics breaking even in an
average of nine months. High utilization by employees and satisfaction with the quality of care were
identified by a majority of the jurisdictions.
Some specific results from contacted jurisdictions include the following:
City of Chattanooga, Tennessee – Although they projected it would take four years to recoup the
costs associated with setting up a clinics, it was achieved in two years. They now project $8.5
million in saving over the next three years on prescriptions alone.
City of Colorado Springs, Colorado – In only ten months, they were showing a $100,000 savings
on healthcare costs working with a nearby nursing school to staff the clinic with professionals and
students.
City of Port St. Lucia, Florida – In less than two years, they had a net savings of $1.5 million.
City of Ocoee, Florida – Although they have only 300 employees, the city saved $350,000 in the
first year.
Initial estimates indicated that Deschutes County could feasibly breakeven within the first year and
experience annual savings of at least $250,000. These initial findings were presented to the Employee
Benefits Advisory Committee (EBAC) at their monthly meeting on January 19, 2010, which was attended
by all three county commissioners. EBAC recommended that a small working group be formed to develop
a Request for Proposal (RFP). The presentation delivered to EBAC was subsequently presented to the
Health Services Department on February 22 and February 23, 2010, and a copy of the presentation slides
were made available to employees via the intranet.
On February 25, 2010, a draft copy of the RFP was reviewed by EBAC’s working group, which included
Dave Kanner (Administration), Ronda Connor (Health Benefits), Dave Inbody (Administration), Dennis
(BOCC), Scott Johnson (Health Services), Timm Schimke (Solid Waste), Tracy Scott (Personnel), Kevin
Harrison (Community Development) and Kelly Elzner (Central Oregon Intergovernmental Council-COIC).
On March 8, 2010, Dave Kanner, Timm Schimke, Ronda Connor and Dave Inbody visited on-site clinics
operated by the State Accident Insurance Fund (SAIF) in Salem and the City of Springfield. These were the
only clinics identified in Oregon for public employees. At EBAC’s March 16, 2010 meeting, EBAC
recommended that the RFP be issued as not only a means to identify a vendor, but also as a research tool to
better understand the clinic options available.
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Request for Proposal (RFP) Process
The RFP was issued on April 5, 2010 with a deadline of April 30, 2010. There were four proposals
submitted from: Healthstat, miCare (EBMS), Bend Memorial Clinic and Medcor. A committee was formed
to review the proposals that included Kanner, Connor, Inbody, Schimke, Scott and Elzner from the working
group, as well as Claudia Wiseman (Health Services), Kathy Christiansen (Health Services) and Wanda
Tigard (COIC). After reviewing the proposals, the committee met on May 4, 2010 and agreed to invite all
four applicants to present their proposals on May 14, 2010. The committee agreed, after the presentations,
that Healthstat and Medcor provided the best proposals.
On May 28, 2010, a conference call was held with Healthstat and Medcor individually to address some of
the questions raised by the committee through the proposal process. Over the next several weeks,
references were checked for each vendor. On June 10 & 11, 2010, Dave Kanner, Ronda Connor and Dave
Inbody did site visits to clinics operated by Healthstat and Medcor. Clinics operated by Healthstat for Santa
Barbara County, California and Reider Corp. were visited as well as the Mammoth Clinic in Yellowstone
National Park operated by Medcor. David Givans, County Auditor, also reviewed two years of financial
statements for both Healthstat and Medcor. In a meeting of the committee on June 15, 2010, it was
recommended that Healthstat be selected to operate Deschutes County’s on-site employee health clinic.
Healthstat
Headquartered in Charlotte, North Carolina, Healthstat was founded in 2001 by Dr. R. Eric Hart. He had
experience assisted manufacturing companies reduce workers’ compensation and occupational medicine
costs through the operation of on-site clinics. He started Healthstat as a means to develop clinics that were
not just for occupational medicine, but also include disease management and personal health services. Hart
currently serves as the company’s Chief Medical Officer. Crockett Dale, after successfully established an
on-site clinic at his textile manufacturing company operated by Healthstat, joined the company in 2004.
Dale currently serves as the company’s President and Chief Executive Officer.
Healthstat operates more than 300 clinics for about 90 clients in 25 states. Some public sector clients
include:
Santa Barbara County in California
Larimer County in Colorado
Durham, New Hanover, Rockingham and Montgomery Counties in North Carolina
City of Charleston in West Virginia
City of Lakeland in Florida
Healthstat is National Committees for Quality Assurance (NCQA) accredited in Wellness and Health
Promotion (WHP). To maintain this accreditation, Healthstat clinics are evaluated on 12 standards of
conduct, including how wellness programs are implemented, how services help individuals make healthy
choices, and how sensitive employee health information is safeguarded. Healthstat is also SAS 70 Level II
certified for all information technology infrastructure, policies and processes. Requires Healthstat to follow
best practices for physical environment, systems access, security of information and facilities, and proper
controls to maintain data integrity.
The primary reasons the committee gave for selecting Healthstat to operate the Deschutes County on-site
clinic were their experience with clinics similar to the model Deschutes County has in mind and their
having established clinics for city and county governments.
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