House calls by primary care doctors have gone the way of the dodo, but "office calls" are just getting started.
Corporations with several thousand employees have long found it cost-effective to offer an onsite clinic with one or more full-time primary care physicians on staff, making it easier for workers to receive routine care without taking a chunk of the day off to commute to a doctor's office.
Now, a new twist lets small to midsize employers bring doctors onsite at in-network rates under the employers' insurance plans.
For example, for an annual subscription fee, Eden Health sends a physician, nurse practitioner or physician's assistant directly to an employer's worksite. How often varies by employer size, said co-founder and CEO Matt McCambridge, "You might get [a visit] two times a year or all the way up to five days a week," he noted.
At tech company Yext, which produces a digital knowledge management platform, a health care professional visits once a quarter. The rest of the year, Yext's New York-based employees can access care at two nearby Manhattan clinics.
As for pricing for these services, McCambridge, while not offering specifics, explained that "tiers differ based on factors such as company size and insurance plans," with costs (separate from insurance plan premiums) comparable to buying staff lunch once or twice a month. Those fees are likely to be offset by other health care cost savings, he said. "If you have a lot of people who go to the hospital in your company—let's say they don't have a primary care doctor—you could be spending a lot more money" than if they had been diagnosed and treated earlier by a primary care doctor, McCambridge said.
Only certain kinds of medical care can be administered at work in a nonclinical setting—"general things you would see a primary doctor for," Yext's Joe Song, vice president of compensation and benefits, said. "We're not doing surgeries in the conference room," he joked.
'We're not doing surgeries in the conference room.'
A New Approach
While providing routine "office calls" by doctors may be new, traditional onsite clinics have become more common—at least at jumbo-size U.S. employers. A 2016 survey by HR consultancy Mercer, with responses from 2,544 employers, found that 40 percent of companies with 20,000 or more employees had onsite or near-site medical clinics for primary care services, up from 25 percent in 2013.
"If employees are using the clinic, it means they haven't been taking time off work to visit a doctor, and they're getting the medical care they need to stay healthy and productive," said David Keyt, a Mercer principal in New York City.
Maintaining their own clinic, however, is a major commitment that most employers are unable to make. The Society for Human Resource Management's (SHRM's) 2018 Employee Benefits Survey, which polled SHRM members at organizations of all sizes earlier this year, found that just 8 percent had an onsite medical clinic, up slightly from 7 percent in 2014.
Telehealth services covering diagnosis, treatment or prescriptions by phone or video are far more common, however: 62 percent of organizations now provide a telehealth option, up from 23 percent in 2016, the first year SHRM asked this question.
A Short Walk to the Doctor
Easy access to health care improves employee productivity, said Yext's Song. Eden's closest clinic is an 8-minute walk from Yext's New York office, where most employees are based, so Song said staff take fewer sick days because they can visit a doctor during lunch.
With just over 800 employees, Yext is large enough to be self-insured but too small to be truly midsize. Before now, McCambridge said, an employer this size couldn't afford to offer direct care. "The biggest companies have been doing some version of onsite health care for a long time," he explained. "But this is one thing that until right around now has not been accessible at a price point for smaller companies."
Telehealth, instead, has become an increasingly popular way for smaller employers to provide access to nonemergency health care, and it can complement at-work doctor visits, as well.
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A Telehealth Component
In addition to Eden's onsite and clinic options, it provides a telemedicine app. Seventy percent of consults are handled remotely by the same clinicians who treat onsite.
"Previously, if you wanted onsite health care, you had to build out a fully supported doctor's office with everything there, often with after-hours care. The technology has allowed us to change that paradigm and have a less expensive, onsite experience," McCambridge said. Doctors don't have to be in the workplace every day to treat the workforce—just enough, he explained, to form relationships.
When they are onsite, Song said, "We book a conference room for the entire day." The clinicians bring their own equipment, and employees book their own appointments. "All we really have to do is greenlight them coming on a given day and make sure they have space," he added.
This ease of use is attractive to Song, who said Yext wasn't considering programs like this when Eden approached Yext's head of HR. Evaluation took around two months, with Yext rolling out the program in November.
Big companies that successfully offer onsite clinics have also started using telehealth to deliver services to employees at multiple worksites, according to a blog post by The Alliance, a midwestern health care cooperative. "Explore that if you want to look for ways to reach your remote or small offices," said Larry Boress, executive director of the National Association of Worksite Health Centers.
Not every employee wants to see a doctor at work. For some, it might feel weird to receive treatment in the same room where they give presentations to their boss.
Privacy was also a concern. The visits require a space co-workers can't see into, so no glass walls or open-office break rooms.
But employees love it, Song said. "Each time [the doctors have] come out, the spots have been full." During the first 90 days, 113 of Yext's 800-plus employees used the program. Across all of Eden Health's clients, McCambridge said, engagement is 64 percent.
HR professionals, Song added, "have to consider the portfolio of benefits we're offering and decide what are the high priorities, then calculate the costs and what we think the ROI [return on investment] would be."
For Yext, he said, offering at-work care "was a matter of productivity and getting employees access to health care, especially given our younger [employee] demographics—making sure that people are seeking out preventative care, especially."
Small Ideas Can Start Something Big
Eden Health is just one example of how health care start-ups with a compelling pitch are attracting the attention of midsize businesses.
"Employers are looking for ways to manage their workers' care more efficiently and not just to burden them with costs through high-deductible plans," which is creating "opportunities for employer-focused businesses that can show real ROI," David Chase, who has studied health care market forces for more than a decade, recently told CNBC.
Midsize employers are particularly open to new, locally launched services that can make primary care more affordable by keeping employees healthier over time, such as by providing onsite health care, Chase noted. "These local, regional ideas that don't seem huge" can "eventually 'bubble up,' " he added.
Terena Bell is a freelance writer in New York City. Stephen Miller, CEBS, contributed to this article.
Related SHRM Articles:
Bringing Personal Services to Work, SHRM Online Benefits, July 2018
Self-Insurance Is Just the Start, Say Health Plan Innovators, SHRM Online Benefits, May 2018
Onsite Health Clinics: What's the Effect on HDHPs and HSAs?, SHRM Online Benefits, November 2017