The Doctor Will See You At Work Now
By Jay Greene
DETROIT - Workplace primary care and wellness centers are catching on in Southeast Michigan as one way for self-funded employers or unions to save money on their health insurance costs and keep their employees healthy and productive.
Three years ago, Plumbers Union Local 98 in Madison Heights contracted with Activate Healthcare of Indianapolis to open a primary care clinic at the union headquarters. So far, union plumbers are saving 30 percent of their health care costs and receiving much quicker access to medical care for themselves and their family, said Danny Nixon, the union's business manager.
Schoolcraft College in Livonia has opened a new 6,000-square-foot urgent care center for students and employees that is managed by St. Joseph Mercy Health System. The site is located on the first floor of the Jeffress Center. Hours are 10 a.m.-10 p.m. Monday through Saturday, and 10 a.m.-6 p.m. Sundays and holidays.
Over the past 18 months, Henry Ford Health System in Detroit has contracted with three Southeast Michigan companies — DTE Energy Co., E & E Manufacturing and Eastman Chemical — to offer primary care and wellness services to about 20,000 people at their worksites, said Susan Greene, the system's director of occupational health. A fourth contract is expected in early 2018, she said.
Dave Spivey, CEO of St. Mary Mercy Livonia, said the Schoolcraft urgent care clinic also is open to the public and is being staffed by doctors with St. Joe's Medical Group. "This facility will increase access to health care and encourage students, employees and others to live healthier lives," he said.
Schoolcraft's urgent care center offers non-emergency medical care on a walk-in basis. Services include health and wellness, including physicals, pregnancy testing and vaccinations.
Since the Affordable Care Act, or Obamacare, was approved in 2010, urgent care and other similarly staffed outpatient centers have exploded in Southeast Michigan and nationally. Data show there are more than 350 urgent care, medical or walk-in clinics in Michigan, including about 110 within 30 miles of Detroit, according to Urgent Care Locations LLC.
Besides hospital-based systems and physicians that operate urgent-care clinics or patient-centered medical homes, a number of corporate-owned companies like Concentra and the more retail-oriented CVS Minute Clinics also provide primary care.
Most health insurers in Southeast Michigan contract with urgent-care centers because of their lower cost relative to emergency rooms, which has further expanded their numbers.
Greene said she saw a number of for-profit worksite clinic companies popping up in Michigan and nationally and thought Henry Ford had the resources to offer the service to employers. Henry Ford's on-site clinic program was born.
"We are Henry Ford, and our business community expects us to be in the mix," said Greene. "Employers are tired of waiting for health care to right-size itself and having an on-site clinic is a way to control expenses and keep employees productive and healthy."
One of Henry Ford's clients, who asked not to be named, has been able to reduce the average costs of visits from about $150 to $78 through improved patient volume. Henry Ford Health said published studies have indicated that return on investment in such clinics can be as large as $2 to $6 per dollar invested.
Local 98's clinic
Debra Geihsler, Activate's principal and co-founder, said the growth of workplace clinics like the one at Local 98 has been strong as employers understand there is a limit to redesigning health plans and shifting costs to employees. Founded in 2010, Activate operates 34 clinics in five states, including one in Southeast Michigan and several others pending, the company said.
"Health care is fragmented and patients get less care than they deserve," said Geihsler, who started her career years ago with Trinity Health and is the former CEO of Harvard Vanguard Medical Group. "If we have a primary care provider managing the whole person, we can avoid catastrophic (medical) events" and lower costs.
Activate averages health care cost reductions of 25 percent and has a return of $1.50 for every $1 invested, Geihsler said.
Nixon said the plumbers union, which has 1,600 active and retired members and 1,900 dependents, decided to add a workplace clinic in June 2014 because medical costs have been rising at double-digit rates the past few years.
For example, plumbers paid $12.50 per hour in 2014 to fund the union's insurance fund. This year, the cost declined to $8.50 per hour, about 45 percent less. Each year, the union workers log about 1.1 million hours, Nixon said. The union contracts out with Benesys Inc., a Troy-based third party administrator.
"We are seeing multiemployer trust funds, what Local 98 is, look to create benefits to members," said Steve Gillie, a consultant who worked with Local 98 to develop the program with Activate. "It helps them control local health care costs and creates a medical home that promotes primary care for wellness."
Nixon said Local 98 is working with Local 636 Pipefitters Union to allow their 2,400 members access to the Activate clinic. Effective Nov. 1, all pipefitter members covered under their health and welfare will be able to use the clinic, he said.
"Activate was great for us. It was a difficult decision because we wanted to make sure it was the right fit and that our members were going to use it," Nixon said. "Generally, men don't go to the doctor unless they are having a heart attack or bleeding out. There is huge benefit of going to the doctor to have preventive medicine available and catch up on these things."
Nixon said member visits were slow, as expected in the beginning, but the clinic continues to experience increased utilization. "(About 58 percent of members) have gone and they are returning for visits, and their family members are going," he said.
The clinic is open variable hours starting as early as 6 a.m. and stays open as late as 7 p.m., depending on the days, for a total of 51 hours per week. It does not charge co-payments and has about 60 prescription medications in stock, he said.
"In addition to full primary care, they are able to receive generic medications and get their lab work done," said Gillie, adding that preventive visits, physical examinations, lab tests and drug testing are available.
Common reasons for visits include common cold, aches and pains. "But we have been able to catch a lot of serious cases — tumors and cancers" — before they became serious, Nixon said.
Gillie said clinic staff, who include a licensed physician, a physician assistant and two medical assistants, routinely coordinate care with members' primary care doctors, hospitals, dentists, imaging centers and other health care providers.
"There is a great working relationship with referrals and specialists," Gillie said. "Now they have a quarterback to do referrals and follow-ups."
Activate union clinic physician Audley Williams, M.D., said he sees a wide range of medical conditions and symptoms, some of which "left unchecked would be devastating for patients." Chronic diseases and conditions include diabetes, high blood pressure, arthritis, lupus and cancer, he said.
"The numbers of patients we see increases every day," said Williams, who has been with the clinic since it opened. "Men see the value in our services. They don't feel ostracized when we have to tell them they need to lose weight."
Recently, the wife of a member came in for a visit and she was diagnosed with a chronic disease.
"She came in for a second look. She had been to this person or that person. In one visit, we found out what was going on," said Williams, who said the clinic model allows for up to an hour with medical professionals. "She was diagnosed with a chronic condition. The workup is not complete, but it can be fatal or cause significant morbidity."
Williams said about one-third of patients do not have a primary care provider, one-third have their own doctor, but another one-third who come in are looking for a change.
"We allow for every member to use us as their primary care clinic, but we want to be respectful with other providers," he said. If patients request or allow, Williams said he will share notes with a primary care provider or refer the member for specialist care.
"We ask the patient if there is someplace they want to go or see," he said. "Depending on insurance, we send the referral. If it is imaging, we are looking for the lowest cost."
Geihsler estimated that 40 percent to 50 percent of employees don't have a personal relationship with a health care provider or hospital. Workplace clinics increase convenience and access for employees, she said.
"We try and reach out to the medically homeless people who don't get their blood pressure checked or annual physical exam," she said. "Organizations tell us their workers increase productivity and have reduced absenteeism. Retention and recruitment of employees have improved."
The doctor will see you at work now.
This article was originally published in Crain's Detroit Business, check it out here.