“Convenient and accessible” may not be the first words that come to mind when contemplating a visit to a health clinic, particularly during the workday. But one of UnityPoint Health’s newer initiatives seeks to change that viewpoint by making access to health services an integral part of the workplace.

The Des Moines-based regional health system three years ago launched UnityPoint at Work, a wholly owned subsidiary that works with companies to create and operate on-site health clinics that exclusively serve their employees. To date, UnityPoint at Work has established nearly 40 on-site clinics for employers across its three-state region that includes Iowa, Illinois and Wisconsin.

“I think the main focus here is to help employers begin to understand how we can improve the health of their employee populations, and do it in a way that’s convenient for the employees by being on the corporate worksite,” said Brian Jones, vice president of payor innovation with UnityPoint Health and CEO of UnityPoint at Work. 

In addition to hospital systems, non-hospital vendors are also seeking to expand the number of on-site and near-site health clinics in Iowa. Activate Healthcare, an Indiana-based company that has expanded into 10 states over the past decade, is currently lining up health care providers and client companies for a planned 2019 entry in the Iowa marketplace. 

The National Association of Worksite Health Centers defines a workplace on-site clinic as “a setting where an employer offers one or more medical and wellness services, delivered by licensed physicians to all or a designated portion of its active population and other eligible individuals.” 

“Cost savings is one of the primary reasons that employers are deciding to do it, since it allows workers to efficiently get care without having to leave the office, often for several hours, for a medical appointment,” said Larry Boress, NAWHC’s executive director. 

Employee satisfaction is also a consideration in establishing an on-site clinic. “These centers often become the biggest benefit an employer offers,” he said. About 60 percent of companies that offer on-site clinics don’t charge their employees any fee for using the clinic. 

Based in Chicago, the 7-year-old trade organization represents more than 80 member companies, which Boress said range across multiple industries and are varying sizes. It does not yet have any Iowa-based companies as members.  

Among Iowa companies that offer on-site clinics are manufacturers such as Vermeer Corp. in Pella and Sukup Manufacturing in Sheffield, which announced in November 2017 it had opened an on-site clinic.

In Greater Des Moines, Meredith Corp. offers an on-site clinic to its employees, as does FBL Financial Group, Nationwide and Corteva Agriscience.  

Meredith takes hybrid approach 

Meredith may well have the oldest on-site employee health clinic in Greater Des Moines, and its preventive services have become a key part of the media company’s wellness program, said Tim O’Neil, Meredith’s executive director of employee benefits and wellness. 

The on-site employee clinic at its Des Moines headquarters dates back at least 100 years, to the days when its magazines were being shipped out by rail, he noted. “That transitioned to a lot of preventive health and physical exams,” he said. “Certainly to things like flu vaccines, travel advisories.” 

About 40 percent of Meredith’s Des Moines employees have used the on-site clinic over the past three years; last year nearly 450 physicals and an equal number of flu shots were provided at the clinic. 

“It doesn’t replace having a primary health care provider,” said Marci Cordaro, manager of employee health and wellness. “We’re just a more convenient setting for basic services like a blood draw or basic first aid.”  

O’Neil said Meredith takes a hybrid approach in how it provides the services, with a registered nurse on staff, augmented by physicians from the Iowa Clinic who visit two mornings each week to conduct physical exams.  

The savings generated by its on-site clinic more than covers its costs, O’Neil said. 

“We track the number of services and the relative value if employees had to leave the office for those services and get reimbursed through the health plan,” he said. “Just strictly the value of the services provided versus the operating cost — not counting the time saved — we’re doing about twice as many services as the cost. That keeps those costs from hitting the medical plan, so that benefits everybody since the company shares the cost of the medical plan with the employees.”  

While most on-site clinics are located in close proximity to the workplace, a growing number are “near-site” or shared clinic locations, serving populations not working in a single location or from multiple employers, according to the NAWHC. That model is also making it possible for employers with smaller worker populations to offer the benefit. 

“We are estimating about 1,500 employers in the United States have on-site or near-site clinics,” Boress said. “Because they’re not regulated, they tend to fly under the radar.” There are also about 30 vendor organizations that offer services in organizing and operating on-site and near-site clinics. 

The majority of employers that offer on-site or near-site clinics are using third-party vendors to operate them, while about 20 percent are doing it all themselves, he said. The remaining 20 percent are doing it through health care systems or other provider groups. 

School systems, local governments on Activate’s radar

On-site health clinics are “a great way for people to get individualized care, and there’s no lack of need,” said Debra Geihsler, co-founder and principal of Activate Healthcare, which is based in Indianapolis. 

Before co-founding Activate Healthcare with former Steak & Shake CEO Peter Dunn, Geihsler was president and CEO of Harvard Vanguard Medical Group and Atrius Health System, a 750,000-patient health system in Boston. Their goal was to start a company that would take a more patient-centered approach to offering on-site clinics, she said. 

Activate, which is in the midst of a national expansion, has been in discussions with several Iowa companies that are seeking to establish on-site clinics, Geihsler said. 

In Iowa, the industries with the greatest potential for offering on-site clinics include school systems and local governments, along with manufacturers and trucking companies, she said. Generally, large organizations with a concentration of employees at one facility, or the ability to easily get to a shared near-site facility, would benefit the most. 

“A lot of our clinics are shared,” Geihsler said, noting that Activate’s first clinic in Indiana serves county employees along with employees of three or four other organizations. Each clinic is staffed with a physician and physician assistant or nurse practitioner, and each offers schedules that rotate between opening early and staying open past normal work hours. “We don’t do 8-5,” she said. 

Activate also provides reciprocity for all of its members, so that employees who are traveling can access an on-site clinic in another part of the country. “So we tend to have a little bit of a mini network,” she said. 

Because of the convenience and the individual attention they offer, on-site clinics tend to generate a high level of employee usage, both Activate and UnityPoint have found. 

Geihsler said that Activate’s on-site clinics range from 65 to 100 percent utilization rates, which is achieved by “providers that relate to the employees, getting the hours right, [and doing it] all at no cost to the members.” 

‘Kind of a game changer’ 

“Employees find them to be very convenient,” said UnityPoint Health’s Jones, who declined to name any of the companies for which it operates on-site clinics. “Because of the proximity to the worksite, it allows for a level of engagement that the employer is looking for to drive programs to lower costs and improve health.” 

Because UnityPoint Health makes fixed payments to its on-site care providers rather than on a fee-for-service basis, it takes away the pressure for them to see 25 to 30 patients a day, which is typical of most traditional clinics. “So they can focus in-depth with concerns that employees have,” he said. “That’s a big driver.” Thirty-minute visits are not uncommon for on-site clinics, he said. 

Jones said he believes that the growing use of accountable care organizations (ACOs) will ultimately drive further growth in on-site health clinics by employers. ACOs enable health care organizations to share risks and savings with insured populations, depending on whether the population’s overall health increases and meets targeted goals. 

“So it’s kind of a game changer,” he said. “We didn’t have that [incentive] five years ago. Now, the ACO and value-based care model has really opened it up to work with employers, because we’re now all on the same 
side of the equation.” 

Consequently, UnityPoint Health is expecting to see continued growth in adoption of on-site clinics, Jones said. “I think a big piece is really educating employers on the opportunities. … We’ve tried a lot of strategies [to lower costs], but I think many employers are realizing they have to improve the health of their employees ultimately to lower costs.” 

Jones said it’s too early to assess the level of cost savings that UnityPoint on-site clinics have generated. 

Activate, which has a 10-year track record, claims that its client companies get an average return of $1.50 on every dollar spent on their on-site clinic, because total health care costs typically go down between 10 percent and 25 percent. Employees, in turn, save more than $350 in co-pays and other avoided costs annually, the company estimates.  

Overall, on-site clinic vendors are competing in a “noisy market” with a host of competitors, Geihsler said. 

“What I would say is happening in the marketplace is that more and more people are becoming aware of this option. I see the marketplace heating up a little more as people move to make a decision.” 
As an example, after opening its first clinic in Nevada one year ago, Activate opened four more and has three or four more under development in that state, she said. The company now operates on-site clinics for more than 100 companies, and by the end of this year it will be providing care for about 130,000 corporate employees, Geihsler said. 

Companies that are interested in exploring on-site clinics as a benefit option need to first understand their employee population and their health needs, Boress said. For instance, an employer may determine that a lot of its workers are taking time during work for chiropractic appointments, so that company may decide to bring in an on-site chiropractor. 

“It’s also important to find out from employees what services they would be willing to use if they were offered on-site, and how much demand there is for offering services to dependents,” he said.