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Health costs related to chronic medical conditions, such as diabetes, represent roughly three-quarters of all health care spending in the U.S., said Brian Jones, senior vice president at hospital and health clinic provider H2U. Speaking on April 8 at the 2013 World Health Care Congress, held near Washington, D.C., Jones said one of the biggest hurdles to effective treatment is that "half of all patients leaving an office visit do not understand what their physician told them."
What's needed is greater communication between the patient and health care provider, and among different care providers. "Relying on the patient to pass along critical treatment information from one provider to another doesn't work," Jones said.
Clinics located onsite at the workplace, or near-site clinics serving several employers, offer an opportunity to create patient-centered "medical homes," Jones explained. Under this model, the clinics work closely with primary care physicians and specialists in the area and act as an overall care coordinator.
"Urgent-care centers are unconnected with primary care physicians and can't pull up patient records from them or share findings with them," said Beth Bierbower, president of the employer group segment at insurer Humana Inc., at the conference.
Another problem is that employee assistance programs (EAPs) and health-coaching services are "actually used little by those with access to them," she noted. "In a system of fragmented care, they become additional fragments." What's missing, Bierbower said, is an integrated and coordinated approach to care.
----------------------------------------------------------------------------In a system of fragmented care, EAPs and health
coaches often become additional fragments.----------------------------------------------------------------------------
Bierbower urged employers to shift their perspective from treating illness to promoting health. Workplace clinics, where appropriate, are one way to oversee health, wellness and disease-management programs together, Jones added.
An example of worksite clinics providing a health-promoting medical home was detailed by Roger Merrill, M.D., chief medical officer at poultry processor Perdue.
According to Merrill, 88 percent of the company's employees participate in the Perdue Health Improvement Program, which includes incentives to promote healthier behaviors and meet health-improvement goals. Onsite testing includes basics such as blood pressure, cholesterol, hemoglobin (diabetes), nicotine use and body mass index.
Data is tracked (using an independent, HIPAA-compliant provider), allowing health coaches to create individualized health-improvement plans. The data also is used to measure plant and enterprise-wide health-status improvements. "This gives us an aggregate 'health score' for each plant and for the company, in addition to generating a personal health score—and a personal plan for health—for each participating [employee]," Merrill said.
"Study data shows very poor returns on telephonic disease management, but onsite care coordinators have access to patients, doctors, nurses and medical records. Suddenly, we have all the tools needed for effective disease management," he added.
The company's primary clinics (called Wellness Centers) operate during all production shifts, and employee visits are on the company's time, which avoids a major disincentive to using them. The clinics draw medical staff from the community, bringing in local doctors to work specified hours as needed, which fosters cooperation with area health systems.
Employees who seek health care at the clinics pay one-third what they would at outside locations, Merrill said. Keeping costs down are factors such as utilization management (providing appropriate, evidence-based care) and health services purchased at wholesale rates.
"Our associates vote with their feet," Merrill said, pointing out that 90 percent of Perdue workers receive care at the onsite centers.
Stephen Miller, CEBS, is an online editor/manager for SHRM.
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