One recession-appropriate idea gaining traction among employers involves teaming up with other companies to share an on-site or near-site health clinic, according to a recent Mercer survey.

About one in 10 participants (11%) share their clinic with another employer, and 13% would consider such a partnership. Small employers (200-999 workers) were the most likely to share a clinic (65%), the survey notes. None of the employers with 10,000 or more workers shared a clinic.

The 2008 national survey represents 345 employers, with 100 of them offering worksite clinics. Many view occupational and primary care clinics as an opportunity to reduce health care costs by providing a lower-cost care option and to improve productivity by reducing absenteeism related to off-site doctor appointments.

"The growing practice of sharing near-site clinics — either one employer opening its on-site clinic to nearby companies' employees or neighboring employers banding together to establish a communal facility — is making it possible for midsize employers, as well as larger employers, to consider this new take on a not-so-new employee health care strategy," says Dr. Bruce Hochstadt, who leads Mercer's worksite clinic consulting group.

On-site primary care clinics mainly provided services for health screenings and immunizations (83% and 81%), followed by treatment of workplace injuries and other emergency care (64 % and 62%), the survey finds.

Nearly 60% of companies report that their clinics are closely linked to wellness initiatives, such as smoking cessation and weight-loss programs, while 51% note that their facilities are primarily focused on occupational health and safety services.

ltiemployer health clinics are efficiencies of scale. "Companies can actually cut some of the expenses by sharing them with other like-minded employers," says Dr. Raymond Zastrow, president for QuadMed, which provides on-site primary care and wellness to large employers.

According to the Mercer survey, 52% of employers explain that the cost of their clinic represents less than 2% of their total health benefits budget, while 19% cite spending on the clinic accounts for 2% to 4.9% of the budget. About one in 10 disclose that the clinic cost 10% or more of total health care spending.

A network of clinics sponsored by several employers also can wipe out the inherent disadvantage of such facilities — inaccessibility for covered dependents. Mercer finds 34% of employers with primary-care on-site clinics cover dependent adults, while 32% covered dependent children. "When you have a network of clinics, you can overcome that challenge," Zastrow says.

For example, in Southeast Wisconsin, QuadMed created a network of five on-site health clinics that are spread throughout the region, serving three large employers. That way, covered dependents who are not near the primary worksite can have access to the same model of care as the worker — especially when it comes to wellness and preventive care — by visiting a nearby clinic, he explains.
H-E-B Grocery Stores is looking into launching primary and preventive care clinics at some of its worksites. Based in San Antonio, H-E-B employs more than 70,000 partners in more than 300 stores across Texas and Mexico.

"Since we are in the retail business, one of the challenges for us is to figure out whether we have enough population density surrounding some stories to sustain one clinic or do we share clinics other employers," says Kathy Durbin, director of benefits. The company might also consider putting a clinic in a motor coach and driving it around to stores on a regular basis.

For Durbin, a partnership with another employer would foremost entail agreeing on primary metrics and delivery-of-care models. The other employer would have to consent that the on-site clinic would use the same protocol for seeing all patients and that the health data would be measured and captured identically, Durbin says.

Mercer's survey data reveal that 75% of employers thought "encouraging employees to make better use of health/wellness programs" as an important or very important objective for on-site clinics, while 74% indicated"control of overall health spending" as an important or very important objective in their decision to sponsor a clinic.

On-site health clinics also resonate with employers because they help reduce the amount of time employees spend out of office due to doctor visits. The clinics allow workers to address medical issues right away, says Paul Rowson, general manager of the Washington, D.C. office of worldatwork, an hr trade association. The mercer data bears out his assertion; 86% of employers say "convenience (in terms of time and effort) for their employees" was an important or very important objective for offering a clinic, while 77% thought "better access to preventive care" was an important or very important objective.

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Employer attitudes about onsite clinics

>> Clinics are popular with health care employers, with 64% operating occupational clinics and 35% offering primary care clinics, Mercer reports. Employers in the manufacturing sector are also more likely to set up occupational and primary care clinics (34% and 17%, respectively).
>> Manufacturing employers generally spend more than other employers (almost one-fifth spends 20% or more of the total health benefits budget on the clinic) because they tend to offer more extensive occupational health services and safety programs to deal with the higher incidence of work-related injuries and exposures.
>> About two-fifths (41%) of respondents charge their employees for clinic services, while 26% give their employees incentives to use the clinic. The typical charge comes in the form of a nominal copay of $5 or $10 per visit.
>> About half of respondents say that fewer than 25% of employees used the clinic in the past year, and one-fourth say that 50% or more used it.