Scott MacStravic, PhD
Ever since America revolted against the old aristocracy of Great Britain in the 18th century and fought an extra war in the 19th century to ensure its separation, we in the US have tended to think we are ahead of our neighbors across the pond. We have assiduously avoided their “descent” into socialized medicine, for example, and frequently crowed about how most people, as long as they are not “medically deprived” can get better medical and hospital care here.
Passing US in Employee Health
But there are increasing signs that the UK is ahead of the US in more than alphabetical order. Thanks to having a national health service, though reflecting the fact that the majority of employers in the UK offer private health insurance options to their employees as supplements to the government version, employers are ahead of their US cousins in employee health management (EHM), for example, at least in what they look for and invest in as desired outcomes.
Employers in the US largely focus exclusively on the most direct and easily measured results of employee (and often dependent) health management, namely reductions in sickness care, workers compensation and disability expenditures. The vast majority avoid focusing on or even measuring the clear impact that employee and dependent health improvement has on absenteeism and productivity at work. Even one of the most progressive HCOs in the country, the Duke University Health System gauges its “Prospective Health Program” aimed at employee and dependent members of its self-insured health plans in terms of direct cost savings alone, seeing the measurement of absence and presenteeism as too difficult.
By contrast, it is routine for UK employers to include absence and productivity at work as major focuses for and measures of success in their EHM efforts. Since they are usually not responsible for much if any of their employees’ and dependents’ sickness care costs, it makes sense for them to leap over these direct success dimensions that dominate US employers’ efforts and focus on overall labor costs, instead. Many UK employers have reported dramatic reductions in sickness-related absences, by more than half in many cases, as well as similar reductions in presenteeism.
Moreover, UK employers have gone beyond cost savings in general, at least in some cases, to examine and celebrate increases in revenue attributed, at least in part, to healthier and happier employees and improved employee retention. Reduced turnover has long been one of the cost saving dimensions included in UK employer ROI evaluations, but at least a few have recognized that having employees remain longer and work at top form increases sales, adds more new business and helps retain customers, as well.
Passing US in Retail Medical Clinics
More recently, there are signs that the UK is jumping on the retail medical clinic bandwagon initiated in the US. But it is passing us in the ways that these clinics are used and the scope of revenue as well as customer benefits they offer. In London, for example, a chain of nine “Medicentres” has opened, many located near the railroad stations where many who work in the city arrive from elsewhere. While they use physicians as their medical care providers, in contrast to the nurse practitioners that staff most such clinics in the US, they offer a far broader range of services and financial arrangements.
For example, its “Medicard Executive” program offers five prepaid physician visits a year, along with an annual flu shot, PSA or Pap Smear test, and discounts on other services and medicat+ions purchased at the centers, for an annual fee of 105 British pounds. It also includes a lifestyle questionnaire and personal health profile customized to the health risks of each client, as well as a “lifestyle book” advising on how clients can lower their risks or keep them down. Discounts include 50 pounds off its comprehensive health assessment screenings, and 25 pounds of the more basic Well Woman or Man screening package.
The Medicentres also offer both occupational and corporate health programs to employers, as ways to achieve the same broad reductions in labor costs as UK employers have shown themselves to be interested in achieving. Occupational Healthcare services are aimed at reducing both health-related employee claims, and improving employee retention by both increasing employee loyalty and reducing health-caused retirements. Many of the screening services can be offered at the worksite, including customized packages that employers request, or at Medicentre locations.
The Corporate Care Programme looks after employee health generally, including full or basic health assessments, up to three prepaid physician visits per year, flu shot, unlimited advice calls to the Medicentre doctor helpline, a comprehensive health screening lasting two hours, biochemistry profile, resting ECG and BMI, hearing, vision, and lung function. The prompt care capabilities of the centers’ locations can reduce time workers spend away from work getting medical care, while advice line calls enable them to avoid unnecessary care or wait to more convenient times when not at work.
At least one retail clinic chain in the US offers proactive health services in addition to traditional routine primary care, at close to the levels of the Medicentres in the UK. The RediClinic clinics (“Get Well. Stay Well…Fast!) operate in five H-E-B stores in Texas, plus three Wal-Mart Supercenters in Oklahoma and Arkansas, plus one in a pharmacy in New York City. Its “Stay Well” services include screenings, immunizations, and routine physicals. But it goes beyond these to offer disease counseling and monitoring for diseases, such as asthma and diabetes), and for risk conditions, such as high cholesterol and blood pressure, overweight and obesity. It creates either a general or comprehensive health profile for patients wishing to manage their health, rather than merely be treated for existing problems. (www.rediclinic.com)
But this is certainly the exception, not the rule in US retail medical clinics. As a consequence, clinics in the US have access to a far smaller revenue potential in terms of the “share of wallet” of the patients it serves, to say nothing of missing entirely the employer and executive markets. By contrast, the recently announced “Preventive Plan” network of Preventive Medicine Centers, to be developed as hospital/physician partnerships across the US by US Preventive Medicine, Inc. might use the UK’s Medicentre’s as a model for their move into the employer health market, with prices similar to those at the Medicentres for packages of services. [“U.S. Preventive Medicine, Inc.” Wall Street Transcript Oct 2, 2006 (reprint provided by company)]
In any case, we are clearly behind the UK in terms of the scope of both our retail medical clinics and our employee health management investments. While the US, fortunately, is known to be ahead of the UK in terms of employee productivity, this advantage may not last long in light of the explicit focus on productivity among UK employers and the willingness of UK providers to work with them toward improving this key national economic parameter.
