With Workplace Clinics, What’s Old Is New

We heard a lot about primary care in the early days of managed care. Gatekeepers were supposed to steer patients to specialists only when necessary, and even limit unnecessary treatment. They still do that, but to a much lesser extent. Remember, we also heard a lot about the Patients’ Bill of Rights. The public revolted against what it perceived as tightly managed care. Just how much gatekeeping actually goes on in health insurance these days would be an interesting research topic, I should think.

We often run articles about primary care, since there is evidence that strong primary care is good for patients and good for payers as well. This issue has a strong focus on primary care — even the factory doc or nurse practitioner, as the case may be.

Our cover story explains how some large employers have decided to get into the primary care business by reaching back to the early days of the Industrial Revolution and setting up onsite clinics. Contributing Editor Maureen Glabman examines the dangers for insurers, but points out opportunities as well.

“The largest employers recognize that cost shifting has run its course, and that is part of the reason for the growth of clinics,” Blaine Bos, a partner at Mercer, the consulting company, told Maureen. Where employers lead, some plans will follow. They may get into the clinic business, and that means primary care.

The medical home is intended to be primary care on steroids, and our story investigates the instruments used to evaluate its effectiveness. Then there are the online physician-only communities, such as Sermo, QuantiaMD, Epocrates, and Medscape, which have opened up a virtual nationwide doctors lounge where physicians (specialists welcome!) can trade advice and sympathy.