Proceeding With Caution On Worksite Clinics

pig“You can claim — and many do — that better access provides worthwhile value, but that’s akin to putting lipstick on a pig.” – Brian Klepper

Proceeding with caution on worksite clinics

By Brian Klepper

Published September 20 2016, 12:42pm EDT

A telling revelation from a September 2015 Mercer survey of 134 worksite clinic sponsors was that “only 41% were able to provide ROI data.” Like vendors in other healthcare sectors, clinic vendors as a group can have wildly different and sometimes questionable ways of calculating health and financial impacts. As someone involved with this sector for some time, my guess is that an even smaller percentage of clinics actually deliver returns on investment.

Obviously it is in clinic vendors’ interests to claim that they save money. It is also in benefits managers’ interests to show that the clinic vendor they were guided to and chose performs. But if, on rigorous analysis, a clinic does not return more than it costs and/or can’t demonstrate enhanced health outcomes, what’s the point? You can claim — and many do — that better access provides worthwhile value, but that’s akin to putting lipstick on a pig.

Don’t get me wrong. Worksite clinics, when structured properly, are profoundly advanced structures that, over an initial three-year period, should drive far better health outcomes, return the sponsor’s investment and lower health plan costs by 20% or more. Benefits managers who aspired to those impacts undoubtedly drove clinic implementation in 29% of firms with 5,000+ employees in 2015, up from 23% just two years before, according to the Mercer survey.

In their best forms, these health centers can be comprehensive primary care medical homes that deliver life management care, walk-in convenience care, occupational health services, chronic disease management, referral management, and so on. They can deliver excellent primary care, but more than that, they can manage the full continuum of clinical and financial risks that drive appropriate and disrupt inappropriate care.

An inescapable and damning conclusion from the Mercer data is that many consultants guiding the choices of poor performing vendors may be asking the wrong questions, may be conflicted by relationships with those vendors, or both. Most probably are not held accountable for urging decisions that turn out to be hugely expensive for their clients.

Many simply don’t know what they don’t know. Clinics are deceptively complex structures. Conventional assumptions may not apply and, while a panel convened by the National Association for Worksite Health Centers (NAWHC) is working to develop consensus on appropriate clinic performance metrics, no standards exist yet. So for the uninitiated, ignorance is bliss until the hoped-for results fail to materialize.

The point is that finding a suitable clinic vendor is not a simple or ordinary benefits purchase. The fact that purchasers choose so few high-performing vendors suggests that better guidance — from consultants with deeper subject matter expertise — is needed. Holding consultants accountable for their recommendations by tying compensation to results is probably the best path to clinic performance. That would improve the clinic assessment process, the caliber of consultants performing the evaluations and hold clinic vendors to a higher standard, driving improvements throughout the sector as well.

Brian Klepper , PHD

Brian Klepper is founding principal of Health Value Direct.

Principal, Health Value Direct


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