"The whole onsite clinic thing has been a buzz the last few years," says Michael Troup, partner at Forsite Benefits.

True enough. But, the Forsite Health & Wellness Center is not your typical worksite clinic. Troup and his fellow partners at Forsite, Tim Mueller and Graham Ness, own and operate the clinic out of Forsite's headquarters in Green Bay, Wis., for use by any employees on their employer-clients' health plans.

The partners started to play around with the idea of opening their own clinic in April 2011 when working with a client that was interested in setting up an onsite clinic. They thought, why not create a cost-efficient model for employer-clients of any size to utilize? Already working with Prevea Health for their wellness program, myInertia, (also owned and operated by Forsite) the trio teamed up with the health care company to provide a nurse practitioner for the would-be facility.

All was agreed to in May, Forsite started building the clinic in June, and it was open for business by October.

For a $15 copay - an additional $10 for lab work - qualified employees receive top-notch care for a range of services, from acute care to chronic condition management.

"Our goal is to go after claims," says Troup. "And if we can go after claims, then we can help our clients. Benefits are becoming more and more of a commodity. I don't care how big of an agency you have; the actuaries are still dictating rates. If we can try to go after the actual claim aspect of things we can start to control a little bit of the cost."

Combined with the myInertia wellness program, "it's all directed around claims savings and ... a dollar you can save on claims can correlate back to premiums," adds Troup. "So that's why we try to give an alternative out there."

Indeed, with an increasing number of employers moving to HSA-driven high-deductible health plans, Ness points out that while it's "created great consumers" out of employees, it's also "created some financial barriers" for many employees to properly manage chronic conditions.

"So you end up with people that are not compliant in the way that they should be," he says.

Having the Forsite Health & Wellness Center available creates a benefit for all involved, Ness explains, as it both removes a financial barrier and helps to increase compliance in managing these conditions for employees, while creating a positive impact for employers due to reduced utilization and claims costs.

As a large number of employees do not have a primary care physician, it gives Prevea the opportunity to engage additional patients in their health care system. As for Forsite, Ness points out, "For us, it clearly separates us from our competition because nobody's offering a service similar to this."


How it works, who it's for

Dr. Ashok Rai, president and CEO of Prevea, one of the largest providers of onsite medical care in the region, has never had another brokerage approach him about such an arrangement, and in conversations with colleagues around the country, he can't recall any other health care companies that have, either.

"The Forsite [clinic] is obviously our most unique because they purchased the clinic from us and we staff it. We bring our electronic medical records on board and they have access to all of our specialists through that," says Dr. Rai of the "mutually beneficial" relationship.

One thing Troup wants to make clear: the clinic is "not a profit center for us," he says. "We're just trying to break even. We have to put some cost on it [for employees] so ... there's some skin in the game, but for employers there's no cost" to participate.

The clinic, which has a separate entrance from Forsite's main office, is open five days a week; 2-6 p.m. Mon.-Thurs. and 7-11 a.m. on Fridays for lab draws.

Although onsite clinics are typically appealing to self-funded employers, the system makes sense for Forsite's large number of fully insured clients as well, due to the high utilization of high-deductible health plans. "It's not unusual to see groups in the $3,000-$5,000 deductible range," says Troup.

While a lot of the cost savings goes to the employer on a self-funded basis, for fully insured plans the savings go to the employee. And if that's not enough incentive to use the clinic, many of Forsite's employer-clients have also decided to construct a plan design where they will pay the $15-$25 cost per visit, making the clinic entirely free for employees. "It's not forced upon anyone," Troup says. "It's an alternative still, but those who use it tend to use it frequently enough that they're seeing those savings. One visit is a savings for them typically."

As for the client's insurance company, they're not involved at all - except for preventative services, those are covered at 100%, and therefore patients are not charged a copay. So, theoretically a diabetic working on reducing his sugar intake could visit the clinic on a regular basis and the insurance company would never know about. Troup compares it to getting into a $600 car accident with a $500 deductible. If you make the claim, your premium will go up.

By taking the place of a reliable mechanic of sorts by providing clients use of the Forsite clinic, Troup, Mueller and Ness hope to target about 20% of claims. That way, says Troup, "you're already ahead of the game in regards to your renewal process."


What makes it successful

Not accepting of the prospect of sitting idly by as health care costs continue to rise and simply "delivering renewals every year and saying, 'Well, there's not much we can do. Here's your renewal,'" the partners now have a solution in the clinic, says Troup, "that can truly impact the bottom line."

"We have this weird passion for this clinic and how it's truly going after claims costs," he says.

While employers will structure their plans to encourage utilization, Troup finds the convenience factor has been a driver as well. Once one or two employees from a particular company use the clinic, word tends to spread and more calls will come in for appointments. Anyone covered under the health plan, including family members, is allowed to use the facility.

Within the first couple of weeks after opening last fall Forsite was getting positive feedback from participants. One client was pleased to receive an email from an employee thanking them for making the clinic available. She explained how, up until that point, she'd been spending her $4,000 deductible on lab costs alone. "She's going to save about $3,600 a year," says Troup.

"It's one of the few business models where every party that's involved in this has something to gain," adds Ness. "The employer can offer a very low-cost benefit to their employees. So in an environment where we're taking benefits away quite often because of escalating health care costs the employer now can say, 'Hey, here's something that we're adding in.'"

It's an opportunity that James Nooyen, business director at Green Bay's Home Instead Senior Care, appreciates being able to bring to his 30 plan-eligible employees.

Nooyen started working with Forsite in 2007. He was drawn to the full array of benefits Forsite offered as a one-stop shop. "Forsite Health & Wellness Center is just another reason why we are happy to be with Forsite. It's just another product, another service that they can offer that's really different than what anybody else offers," says Nooyen.

"What it provided was a lot of our employees an opportunity to get some regular ongoing treatment that they had done where they were able to get that at a significantly reduced cost."

While some of his employees have taken advantage of the clinic for sick visits, he notes one woman who estimates she'll be saving around $2,300 a year by using the clinic for chronic care treatment.

"It's a creative way to manage rising health care costs," says Nooyen, "and by taking away some of the added overhead and providing more direct access to health care professionals it's better for the employer, it's better for the employee. And obviously it's better for the insurance company in the end if everyone is saving money. So I really think it's a creative way to save on health care costs."


How it's changed their outlook

The appreciation from clients is not lost on Ness, who notes, "It's not real often that employers are thanked and not real often that we as benefit consultants are thanked for the benefit structure that's put into play."

Of course, at a time of great uncertainty for the employee benefit broker, it wasn't without some trepidation that the Forsite partners took on such a large expansion of their business. "The biggest fear, as we take a look at it, is investment in this industry is very difficult just because of health care reform," says Troup. "So do you put the money into it? ... Do you really want to spend $200,000 to put in the facility? Everything just made so much sense that we said yes."

Some of the anxiety stemmed from the rush process of needing to quickly build a new office (across from their old facility) to accommodate the clinic in time for the opening, says Mueller. "Not only were we learning about the health care delivery system, but we were learning a lot about building and how to manage that aspect of it," he says. "It was fun. It really was fun. I don't know if I would have said that exactly at the time, but ... obviously it was an exciting time for us because in essence we made a commitment to do this and it changed the way we did business.

"We were a consulting firm specializing in insurance benefits and suddenly we're getting into the health care community, direct health care delivery."

Beginning with their myInertia wellness program, which was structured to be different from competitors by owning it themselves and hiring their own programmers, the Forsite partners are "always looking for that other edge," says Troup. "As I started to think through the concept of what does this mean to our clients and what does it mean to our prospects it started to become more and more of a no-brainer for us - that our cost to put it in place really [was] outweighed [by] the value to our clients and potential growth as a business for us."

And in the nine-plus months since the clinic opened the firm is already seeing the benefits.

"We've had a very strong year this year," says Troup. "I'd like to say it's more than just the clinic, but that clinic is a huge differentiator.

"We're competing against in this market some big, national agencies and it's great to take business away from those big agencies. Although I'm friends with all of the individuals that work at those places, it's nice to go in and have a value proposition that's greater than what they can offer on a national basis."

At the end of the day, the motivating factor for Forsite, says Mueller, "is we realized it really was the right thing to do.

"When we see these people come in through the clinic that they're saving a ton of money, they will take the time and form a relationship with the nurse practitioner we have here, when they're routinely coming in and taking care of those chronic conditions we're starting to see it's making a difference and it's making health care easily available to them."

The positive vibe has Forsite's staff of 13 employees motivated and energized - a differentiating factor of its own for an employee benefits firm these days.

"Certainly with a lot of the things looming over health care reform that uncertainty kind of spills over into the outlook and attitude of most people in our industry," says Ness. "We've really taken a different look at things, trying to stay with our heads up and the mindset that with change comes opportunity. And our staff has seen that really that is the mindset that we have.

"It isn't gloom-and-doom," he adds. "We're going to continue to do what we feel is the right thing. We're going to take smart chances and this is something that's clearly paying off for us, and our staff sees that we're genuinely committed to our business in the long term and making sure that things work and that we continue to grow the business. Not just resting on our feet and waiting to see what's delivered to us by health care reform."


Expansion plans

In fact, they have ambitious plans for expansion. In the next six months Forsite hopes to build upon the existing single clinic room and add physical therapy capabilities and two additional clinic rooms to the Forsite Health & Wellness Center.

With an eye on utilization rates, they also want to add hours and another nurse practitioner. The goal is to have the clinic open from 7 a.m. to 6 p.m. weekdays, with Saturday hours as well, says Troup.

Taking the business model even further, the partners are also discussing how they can help brokerages in other states in some type of partnership structure, be it franchise or consulting, "just because we've had so much experience running it and how the model works," says Troup.

From the health care system perspective, Dr. Rai urges other brokerages considering the model not to go at it alone.

"There's two ways you could do it," he says. "You could try to do it on your own, you could find a nurse practitioner, go through one of the companies that has onsite clinics. But my ultimate advice is to partner with a health care system when doing it. That way your clinic has value to it. It has more than just a primary care base. It has access to a specialist; it has access to hospital information. And having the electronic medical record tied into all that [reduces] duplication."

Not partnering with a health care system, says Dr. Rai, provides the face value of a lower hourly rate, but not the long-term value of connecting patients with a larger health care system.

Mueller mentions how other agencies have contacted Forsite about how they can duplicate the success of their clinic and says, "It's a great model and I think it just takes the right agency to be open-minded about it."

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