Scott MacStravic, PhD
There are a growing number of hospitals that have taken the plunge by offering employee health management (EHM) services – to their own employees, to local or even national employers, or both. They are necessarily challenged competitively in terms of costs, since hospitals have long held a spot near the top among sources of sickness care. But they are also challenged with respect to convenience, for participants since they are the most critical determinant of EHM success.
Hospitals used to have only one location, for example, until they began merging with or acquiring, as well as building new locations in the suburbs in pursuit of more well-paying patients. But even so, the number of locations they offer tends to be in the single digits for any one market, and their locations are often not the most convenient to where workers live. Even when they offer multiple locations, hospitals tend toward “bankers’ hours” in terms of the hours their outpatient services are available.
By contrast, physicians’ practices, particularly of the primary physicians that engage in EHM, tend to have far more locations, and to be located closer to more workers, then the typical hospital. Of course, the hospital may limit its role in an EHM strategy or program to services that require relatively infrequent visits, and serve large numbers of patients at the same time, such as group education or screening for people with the same EHM challenge or goal.
For example, the Diabetes & Nutrition Center at Northeast Medical Center, in Concord, North Carolina (www.northeastmedical.org) provides back-up for its 20 primary physician practices in managing the risk among diabetic patients. Education sessions, including an intensive assessment and intake individual visit, along with a limited number of follow-up visits, preferably in groups, are provided as needed, to promote patient compliance with their medications and lifestyle regimens. Such visits are covered by Medicare, though with a strict limit of ten visits in the first year, and two visits per year thereafter, which may be individual or group visits. Commercial insurance or employers paying for such services may be more generous.
Another competing option, however, is the multiple sites, extended hours, and convenient location (as well as free parking) that characterize retail clinics. While most of these clinics offer mainly routine sickness care services, most also offer flu shots and some screening services, that can be used to track progress of EHM participants, such as blood pressure, weight, and similar checks. And at least one chain of such clinics is already heavily into “Stay Well” EHM services, in addition to traditional “Get Well” care.
The RediClinic chain, which already has 19 locations in the US, with twelve of them in the greater Houston area, in a joint venture with Memorial Hermann Healthcare System, is a good example. A recent CDC study reported that “…retail clinics are particularly well-suited to the delivery of preventive care…that can produce superior returns on terms of employee health improvements and cost savings…(such as) smoking cessation, adult immunizations…and screenings for hypertension, cholesterol and diabetes.” [“Houston Employers Hear New Research That Supports the Case for Retail Clinics” ResidentandStaff.com Oct 29, 2007]
Even more convenient are the growing number of “worksite medical clinics” that operate right were employees work, including some that serve multiple employers who happen to occupy the same campus. These were once used solely for routine occupational health or other sickness care, to save money on charges, and save employees lost time seeking care elsewhere. But they have recently added the mission of promoting employee health and managing chronic disease so as to minimize the use of sickness care, and reduce both absenteeism and presenteeism causes of worker productivity and performance impairment.
Hospitals could be overall sponsors of worksite clinics just as Memorial Hermann is of retail clinics, hiring and supervising physicians or nurse practitioners, as well as other staff needed in EHM programs. And they could certainly function as does Northeast Medical Center in providing services for large numbers at their own sites, where this is more efficient, when such services are not used frequently. Already, the hospitals that are partnering with U.S. Preventive Medicine, Inc. in its Centers for Preventive Medicine and its Prevention Plan, described as paying off for employers:
The tough EHM suppliers for hospitals to compete with would naturally be those that do not rely on one or even many places or times, but deliver EHM initiatives online, via website visits, or by mail. Health risk assessments (HRAs) and their feedback, together with continuous and customized communications can be delivered by such means, whereby participants totally control where and when they get the interactions they want. Since such methods tend to be the lowest-cost EHM options, as well, they are that much more convenient.
The only way that hospitals can compete with the convenience of online options is to either join ‘em, as has the Mayo Clinic, for example, that offers online EHM services to some 70 employers in the U.S., or to deliver significantly better outcomes, for both employers and employees, given higher costs. Convenience will always be a major factor in determining both participation and success rates for EHM interventions, but the ultimate test is what the results turn out to be.
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