On-Site Corporate Health Clinics - The Growing Role of Doctors of Chiropractic

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On-Site Corporate Health Clinics

Originally conceived by large employers at least 70 years ago[1] as a center for treating work related injuries, adding a benefit for high-wage employees, or minimizing employees’ time away from work,[2] on-site corporate health clinics have evolved into a new and expanded model. Today, these clinics reflect post-health care reforms and address a myriad of challenges: control and reduce health care costs, enhance access to primary care, and function as a medical home for employees and their dependents.

Employers increasingly consider on-site corporate health clinics as a vital component of corporate health and wellness strategies that aim to measurably improve employee productivity, integrate wellness initiatives, and provide an employment benefit comparable to other employers. In some cases, these clinics result in better control of corporate health care expenditures through on-site screening for chronic diseases and active condition management.

That’s a tall order for any health care delivery model, but one that continues to earn market confidence. In 2009, Fuld & Co., a research organization, predicted that the number of corporate on-site health clinics would swell to 7,000 by 2015, and would serve about 10 percent of the U.S. population under age 65.[3] Several organizations tracking this trend, as well as the ever increasing scope of services offered, have provided key statistics:

• National Business Group on Health shared in a 2013 survey that 44 percent of large employers have on-site corporate health clinics, and nine percent were considering the introduction of one.[4]

• Mercer’s (New York) most recent National Survey of Employer-Sponsored Health Plans, released in November 2012, indicated 37 percent of firms with 5,000 or more employees reported they offer occupational and/or primary care services through an on-site corporate health clinic, compared with 32 percent in 2010. Another 15 percent indicated they are considering installing a clinic within the next two years.

• On-site corporate health clinics were slightly less popular with mid-size employers. About 30 percent of employers with > 500 employees said they currently offer on-site services, while nine percent said they may begin offering on-site occupational health services, and 15 percent said they are considering offering primary health care services by 2014.

• The National Association of Worksite Health Centers (www.nawhc.org), the nation’s only nonprofit association supporting employer sponsors of on-site, near-site, mobile health, fitness and wellness centers, studied U.S. employers during the period of Nov. 2013-March 2014. There were 275 total responses: 116 of respondents were employers indicating that they had an on-site or near-site clinic. Results are shown for those with <1000 1="" and="" employees="">10,000 employees:

Results of 2014 National Survey of Onsite Clinic Operations and Policies

EMPLOYER ADOPTION OF ON-SITE CLINICS

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[1] Brugh, Victor M., M.D.; McCarthy, Mac; Why Establish On-site Care: Employer-Sponsored Medical Clinics: Much More Than Convenience Care; Benefits Quarterly, first quarter 2014, International Society of Certified Employee Benefit Specialists; https://www.iscebs.org/Documents/PDF/bqpublic/BQ1_2014.pdf; Accessed October 27, 2014

[2] Boukus, Ellyn R, Cohen, Genna R., Tu, Ha T.; Growing Employer Demand for Workplace Clinics; HSC Research Brief No. 17; Center for Studying Health System Change, December 2010; http://www.hschange.com/CONTENT/1166/; Accessed October 27, 2014

[3] Fuld & Company; The Growth of On-Site Health Clinics, 2009; http://www.yourhealthstat.com/files/article/The%20Growth%20of%20On-Site%20Clinics%20(Feb%202009).pdf; Accessed January 6, 2015

[4] Towers Watson/National Business Group on Health. (2013). Reshaping health care: Best performers leading the way. Retrieved from http://www.towerswatson.com/en-US/Insights/IC-Types/

Survey-Research-Results/2013/03/Towers-Watson-NBGH-Employer-Survey-on-Value-in-Purchasing-Health-Care.

“Conservative Care First” is more important today than ever in facing our nation’s healthcare challenges

Chiropractic physicians are the highest-rated healthcare practitioners for low-back pain treatments with their patient-centered, whole-person approach that provides greater interaction and communication for appropriate diagnosis and developing more cost-effective treatment planning.

 

October is National Chiropractic Health Month

Spine Health Program Overview

A compelling argument could be made that the most inefficient and ineffective area of health care is spine pain management. Nationally, direct costs of spine care have gone up six to eight times over the last 20 years accompanied by an even more dramatic increase in indirect costs (lost work days, decreased productivity). The bottom line: we are putting significantly more money into spine care, with worse outcomes.

The Spine Care Program offered by Lifetime Health Medical Group and Excellus BlueCross BlueShield is designed to address this issue. The program is based on a spine care pathway created by Spine Care Partners© and currently being implemented in hospital systems, ACOs and PCMHs as well as privately operated PCP and specialty groups.

The core of the program is an evidence-based, patient centered spine pathway based on a biopsychosocial model of care. Strong emphasis is put on patient choice, education and motivation in self-care. Educational websites, applications and specific self-care tools are being developed to support these patient directed efforts. Care is co-ordinated by a Primary Spine Practitioner (PSP), a licensed health care provider (i.e. physician, physical therapist, chiropractor, nurse practitioner). The PSP is trained in the pathway and necessary diagnostic, treatment and communication skill sets to effectively manage most cases by treating 85+% of spine patients and triage the rest to appropriate care.

PSPs are the hub of the diagnostic, management and treatment wheel. Relational care concepts create the infrastructure of the PSP/patient interactions, using validated psychosocial questionnaires and motivational interviewing techniques to more accurately access the ‘whole person’ impact of the spine condition and modify treatment and language used to motivate patients to fully participate in their own recovery and future management.

Another unique element of the program is the use of a multidisciplinary team of spine care providers to provide fast, effective quality patient care. The team seamlessly interacts to deliver a virtual value add, process driven model of spine care. Team members are identified through data, experience and peer recommendation. As “fast track” providers, they ensure pre-screened patients access to services within one-two business days, allowing quicker access to second level providers than can be acquired through a typical PCP/specialist interaction. This, in turn, allows ‘teachable moments’ between PSPs and PCPs, outline alternative and evidence based options to early or non-evidence based use of surgeons, injections, imaging and opioids. Evidence-supported shared decision making tools are discussed with patients with each pathway provider encountered. These concepts are supported by employer and community based public spine health initiatives, when possible.

Our spine program quality goals are aimed at better value through optimizing patient provider match, invoking process to the full spectrum of spine care (adding efficiencies via pathway adherence), and identifying psychosocial issues or early signs of perpetuating factors. We then align patient specific resources to address these early indicators of possible chronicity. We are early in our program, but our 'fast track' neurosurgeons enjoy the higher quality surgical patients they are seeing. We feel the timing of surgical intervention is often sub-optimal (too early, too late...) and these front end efficiencies help to right size the timing and the care.

Using data collection tools to examine episodes of care will allow us to monitor cost shifting and overall spine care costs. Strict outcome and patient satisfaction data will allow us to derive value measures to the individual practitioner or provider group level. Quality of life data and spinal registries are on the horizon.

We are evolving the program to a community-wide Spine Care Program to improve clinical outcomes (function, quality of life), the patient experience (patient satisfaction, patient directed outcome measures), and guide appropriate utilization of healthcare resources related to spine care (high value care).

For questions, research articles, or additional information, please contact: Brian Justice brian.justice@excellus.com