As the landscape of
employer-sponsored benefit plans continues to change, one
thing remains constant for businesses – the need to contain
healthcare costs. A shift to occupational wellness and
preventive care measures has pushed employers to find more
creative ways of impacting their claims costs, and the advent
of healthcare reform is creating additional incentive to
follow through with those ideas. But one particular
concept that is becoming more appealing to employers – even
those in the small business segment – is the use of onsite
clinics.
Onsite clinics have been used for
decades by employers to address the health concerns of its
employees and their family members. Their popularity
among the business community was based upon the premise that
these clinics could not only save employers money in relation
to the direct healthcare spending, but also in relation to
their indirect costs, such as lost work time, lost
productivity, and employee turnover.
When done properly, these clinics
can be both medically and financially beneficial for both
companies and employees. While the current reimbursement
system for physician practices offers little incentive to
spend additional time on prevention or health awareness,
onsite clinics are often designed to bring the approaches of
treatment and prevention together for a better overall
outcome. The use of annual personal health assessments
to identify unhealthy behaviors that lead to preventable
conditions is just one example of how these clinics are able
to enhance both enhance employee health and limit unnecessary
employer cost.
Impact on Consumer-Driven
Plans
Onsite (and near-site) clinics are also
evolving to meet the emerging “patient-centered” era of
consumer directed healthcare integrated with wellness and
disease management programs. Many employers are looking
at the advantages of engaging in onsite care as a way to help
employees manage the cost of high deductible health plans –
typically combined with health reimbursement arrangements
(HRA) and health savings accounts (HSA) – giving them easier
access to low cost care.
HSA accounts, however, have posed
some new challenges when designing how employees will pay for
care that is rendered at an onsite clinic. Employers
often try to absorb the entire cost of the employee’s visit or
charge a minimal amount to utilize their clinic in order to
incent utilization. But while current HSA rules under IRS Notice 2008-59 allow an employer’s onsite clinic to offer
preventive care (plus other “insignificant” medical benefits)
without jeopardizing an employee’s HSA eligibility, the
payment for non-preventive medical care or treatments may
violate the HSA first-coverage rules. It is because of
this that employers should take great care in the design of
their onsite clinics to ensure that they do not adversely
affect employees' HSA eligibility. In fact, some
employers are learning when offering different types of plans
(traditional PPO’s alongside consumer driven plans), it is
quite possible that HSA participants will have to pay for care
while those on other plans may receive free or discounted
services.
Employer Size Becoming Less
of a Factor
Typically, a critical mass of
employees is necessary for onsite healthcare facilities to be
successful. In general, onsite clinics are found in
companies that have over 2,000 employees at a particular site.
That can certainly fluctuate, however, particularly in cases
where employees' dependents have access as well.
But a new trend is emerging where
smaller companies that are interested in establishing onsite
clinics but cannot do so alone can work with another employer
or group of employers to set up a shared facility for their
workers. In addition, small employers are finding it
easier to offer onsite facilities in coordination with remote
services such as TelaDoc, which allows employees to phone in
for a diagnosis and get medication prescribed over the
phone. Such developments are creating a broader scope of
acceptance among U.S. businesses.
The Bottom
Line
While the trend of onsite clinics is
continuing to grow, several employers are still focused on how
these facilities will impact them financially. Current
studies vary on what the average return-on-investment is for
employers, but most indicate an ROI can range from $1 to $4
for every dollar invested over a two-year period of
time. However, the true measure of these clinics may not
be realized until further down the road when the full impact
of their prevention services can result in the healthier
lifestyles of the employees.
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