Commentary: Onsite clinics are becoming an increasingly important component of employers’ health and productivity strategies. Recent surveys have found that adoption of onsite clinics is growing at double-digit rates, and the majority of employers plan to expand the services offered at existing clinics.
However, many employers struggle to determine the impact of their investments. It’s always tough to measure healthcare programs and initiatives. However, onsite clinics are particularly complex because they serve a broad population base with diverse healthcare needs (e.g., a healthy employee with a common cold, a diabetic patient with several comorbid conditions).
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Consider structuring your analysis around three primary sources of value that onsite clinics deliver:
1. Expanding access to care. Employers are putting clinics on site to help their employees more easily take care of themselves, and thus stay healthy and productive.Therefore, a goodstarting point for assessing an onsite clinic is to ask, “Are my employees using it?” Your onsite clinic vendor likely provides detailed reporting on utilization and patient satisfaction, which is a particularly important indicator since repeat usage typically drives over 70% of clinic utilization. Review the most common diagnosis and procedure codes at the clinic to understand why and how it is being used. Are patients visiting for the common cold? An immunization? Or for help managing a chronic condition? Assess whether clinic visitors had a relationship with a PCP prior to visiting the clinic to further clarify its role in expanding access. Lastly, understand the demographics (age, gender, location) of clinic visitors to determine how well the clinic reaches your target population.
2. Improving population health. Next, it’s important to quantify how clinic usage is improving the health of the population. Start by identifying visitors’ top health conditions to ensure that the clinic has the right staffing and programs in place. Trend quality measures for the top conditions, as well as general measures for preventive care, to help assess whether clinic visits are leading to improved care compliance. A comparable location not served by a clinic provides a natural control group. If possible, incorporate data from health risk assessments or biometric screenings to further demonstrate whether the clinic drives improved outcomes.
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3. Managing the cost of care. A final source of value from a clinic is reduction in direct and indirect healthcare costs. Unlike other types of health improvement interventions, onsite clinics can help reduce costs by lowering both the unit costs of services and keeping people healthy and out of the hospital. In the short term, lower costs on routine procedures such as office visits and lab tests are most likely to drive savings. Track the “capture rate,” or the percentage of services performed in the clinic vs. elsewhere, to monitor this opportunity.
The clinic’s impact on chronic condition management may also lead to reductions in inpatient and emergency department utilization. However, it can be challenging to establish this link in the short term. Once you have access to multiple years of data, you can look for decreases in risk-adjusted acute care utilization rates and other metrics, such as ambulatory care sensitive admissions and avoidable emergency department visits. Be sure to factor cost increases related to increased primary care and pharmacy utilization into any savings estimate.
Finally, onsite clinics can also influence other indirect costs, such as absence and productivity.If possible, incorporate absence data to understand whether improved access to care contributes to lower rates of absence and associated costs.
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Segmenting your population can provide additional clarity into the three sources of onsite clinic value. For example, focus on a high-risk patient cohort, such as diabetics, or a specific part of your workforce. We’ve found that segmenting based on visit frequency (e.g., visited once, visited multiple times) provides useful insight into the profile of patients who drive clinic usage.
Of course, the analyses above rely on the right data. At a minimum, ensure that your onsite clinic vendor provides a data feed to your analytics partner that includes diagnosis and procedure codes for services performed in the clinic. Many onsite clinic vendors can submit this data to health plans to be aggregated with other medical claims.
After a clinic is opened, employers have many opportunities to drive incremental value, including adjusting staffing levels, offering new services, and refining communications strategies to drive utilization. Lessons from a first location can be applied to identify other sites best suited for expansion. By establishing a holistic framework to measure the value of onsite clinics, employers can optimize ongoing clinic operations and establish the program as a central component of their health and productivity strategy.
Sam Stearns is vice president of analytics and consulting for
