Workplace health clinics used to be a lot like the school nurse's office, dispensing Band-Aids, treating occupational injuries, and serving as a first stop for emergencies like asthma attacks.
But as companies face rising insurance costs and an aging workforce, they're turning clinics into something new: A place to aggressively nudge employees about long-term, expensive conditions such as diabetes, hypertension and high cholesterol.
There is more money than ever at stake. Chronic diseases account for more than 65% of all corporate health-care spending, according to a 2012 Aon Hewitt report.
Employers also see on-site care as a way to minimize time lost to sick days and doctor visits, and to retain staff at a time when they can't afford big raises.
But the clinics, which are generally staffed by nurses and health coaches and run like a regular doctor's office, also raise concerns about privacy and the deeper intrusion of employers into workers' health and personal lives.
'This is where the action is as far as improving employees' health,' said Allan Khoury, a senior consultant at health-care consultancy Towers Watson .
-Care for occupational injuries
-Hearing exams
-Flu shots
-Physical therapy
-Mental-health services
-Primary care
-Biometric screenings
-Vaccinations
-Allergy shots
In 2012, 28% of large U.S. employers hosted on-site medical clinics, and 39% will have them by 2014, a Towers Watson survey found. The figure in 2011 was 23%.
The toll of seven of the most common chronic illnesses, in costs and lost productivity, is expected to hit $4.2 trillion in 2023, according to the Milken Institute, up from $1.3 trillion in 2003. Consultants and health-care providers are advising employers to add chronic-disease management-from regular blood and glucose tests to nutrition and lifestyle coaching-to their clinic offerings in order to reach the most expensive subset of employees.
While treatment is voluntary, clinic operators-most on-site facilities are operated by third parties-review employees' health screenings and surveys to target those who have, or are at risk for, chronic conditions. The clinic operators call and email employees, and sometimes lure workers with gift cards or discounts on premiums to get them into the clinic.
At Hanesbrands Inc., rising rates of chronic diseases among its workforce led the company to open a clinic in 2010 at its Winston-Salem, N.C., headquarters. The company tapped CHS Health Services to run the facility and insisted that all services be provided free.
'You have to take away the obstacles, and copays are an obstacle,' said Annamarie D'Souza, vice president of compensation and benefits.
Since the clinic opened, Hanesbrands has seen a 30% drop in emergency-room visits among insured workers and a 39% drop in inpatient hospital admissions. Of the employees with diabetes, 50% are 'engaged' with the clinic and showing improvement in a key blood-sugar reading, said Ms. D'Souza.
The company estimates it has saved $1.4 million annually in the clinic's first two years, based on what Hanesbrands, which is self-insured, would have paid in claims for services as well as reduced costs from early identification of disease risks. Hanesbrands has also kept total health-care cost increases to an average of 2.5% over the last five years, versus a national growth rate of 5% to 10%.
John Martin, an accounts-payable specialist at Hanesbrands, visited the company clinic in January after leaving his Type 2 diabetes untreated for seven years. Tests confirmed that the 53-year-old's blood sugar was high and that he also suffered from hypertension. Clinic nurse practitioners put Mr. Martin on medication for both conditions and arranged for free or discounted pills. A CHS health coach helped him lose 25 pounds in two months through dietary changes and an exercise program.
'This has made me change the way I live my life,' Mr. Martin said of the clinic.
By taking on the management of conditions once overseen by personal doctors, such clinics essentially become primary-care facilities, filling a need that will become more acute when the Affordable Care Act is implemented, said Stuart Clark, CEO of CHS Health Services, which operates more than 100 clinics.
While clinics are convenient, some fear that employers' growing engagement with workers' health and lifestyle could lead to privacy violations or discrimination.
'Anytime there's something paid for by the company, there's always the possibility that they will raid the data,' using it to penalize or even fire unhealthy workers, said Deborah Peel, founder of the nonprofit group Patient Privacy Rights. Employees at some companies, including Michelin North America Inc., already pay more for care if their screenings turn up high blood pressure or oversize waistlines.
Employers say they weigh such concerns when opening clinics. 'We may get a complaint or question occasionally but...we're very aware of privacy and HIPAA,' the federal law that regulates use of patients' medical information, said Kendell Sherrer, vice president of benefits at drug distributor Cardinal Health Inc., which has a clinic at its Dublin, Ohio, headquarters.
When Cardinal's clinic opened in 2010, mainly offering emergency care, providers discovered that many employees didn't have a primary-care physician they were seeing regularly. Last year, it added primary care to its roster of services, allowing it to monitor and treat chronic conditions.
Fifty-six percent of employees who completed screenings and assessments were recently identified as being at risk for key health problems. The company's clinic provider, a division of Walgreen Co., reached out to those workers and, so far, about 20% have registered for health coaching, which involves guidance around diet, exercise and medication regimens.
'Over time, we'll be able to see where employees score on screenings and we'll hopefully see the gauge move to healthier levels,' said Mr. Sherrer.
Write to Lauren Weber at lauren.weber@wsj.com
A version of this article appeared July 10, 2013, on page B1 in the U.S. edition of The Wall Street Journal, with the headline: The Office Nurse Now Treats Diabetes, Not Headaches.
Published on : Thursday, July 11, 2013
Category : Diabetes
Post URL : http://internal-med.blogspot.com/2013/07/the-office-nurse-now-treats-diabetes.html
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