Onsite health clinics are rapidly becoming the hottest trend in population health. According to Mercer, 29% of organizations with 5,000 or more employees offered some type of onsite health clinic in 2015, up from 24% in 2014. It’s not just large corporations, either. Earlier this year, the Fairfield County School District in Ohio became the first suburban school system in the country to offer health, dental, vision and mental health services in a single location.
The logic of the onsite health clinic is hard to ignore. When it is easy and inexpensive for people to access care without having to go outside of their normal routine to get to a doctor’s office, consumers are more likely to address health issues earlier, ultimately avoiding costly emergency and specialist care down the road.
Unfortunately, in the real world, implementation and maintenance of an onsite health clinic is not quite as simple as the logic would suggest. For one, they cost a lot. For very large employers — those with 25,000 to 50,000 employees — it is not uncommon for the annual operating costs for an onsite clinic to fall into the $2 million to $3 million range. For any company operating in today’s ultra-competitive economy, a line item that big is going to have to be justified with commensurate savings in overall healthcare costs.
That’s where measurement becomes so critical. For every highly publicized anecdote about an onsite health clinic that has been shown to reduce ER admissions or improve disease management for people with chronic conditions, there are many lower-profile stories of companies that are struggling to justify the cost of their clinics.
The difference between the two is hard, quantitative evidence. To be useful, however, this evidence needs to dig much deeper into the utilization patterns and corresponding outcomes than a simple cost-benefit analysis. To truly understand the value an onsite health clinic is delivering — and to prepare yourself to address potential shortcomings before they become major problems — it is important to track a number of key variables.
Quote“Only by constantly measuring and assessing detailed clinical and administrative data can an onsite clinic truly identify its strengths and weaknesses.”
In our work helping some of the largest corporations in the world develop and continually evaluate the effectiveness of their onsite health clinic programs, we’ve identified a set of six core measures that should be included in any major health clinic assessment.
· Utilization: This baseline step includes a measure of how many employees are using the clinic versus those who are not, frequency of visits, type of visits, top conditions seen in the clinic during different service periods, and distribution of patients by condition, provider type, and referrals over time.
· Clinical services by procedure group: A categorization of type of office visit, supplies and medications dispensed, screenings ordered and procedures conducted.
· Financial overview: Total operating costs versus estimated gross healthcare cost savings over multiple time periods.
· Demographics: Profiles of clinic users versus non-users screened against age, sex, health risk and utilization patterns.
· Quality of care and outcomes: Frequency of required screenings, appropriate care for common conditions and tests associated with specific conditions in the user population versus the non-user population.
· Staff configuration: Total number of physicians, mid-level providers, providers and support staff and related workload and productivity for each.
Only by constantly measuring and assessing detailed clinical and administrative data can an onsite clinic truly identify its strengths and weaknesses. The latter are just as important as the former when it comes to performance improvement. While it’s great to read about anecdotal successes at a single clinic, the real victory for the industry will come when all clinics are delivering meaningful health improvements to large populations. To get there, we’re going to need to sweat the details.
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