The Growing Appeal of On-the-job Health Care

Large employers are increasingly setting up health clinics on-site or near workplaces to encourage workers to keep on top of basic and chronic health problems in hopes of keeping medical costs down. A 2018 Mercer survey found a third of employers with 5,000 or more employees had clinics, up from a quarter in 2012.

Self-insured employers increasingly see themselves as financially responsible for the health status of their employees— and, often, their dependents. So there are multiple incentives to set up health clinics: providing a primary care provider to the many employees who don’t have one, helping workers with chronic conditions manage them, reducing time away from work for medical appointments, and increasing employee satisfaction.

Another advantage, says Larry Boress, executive director of the National Association of Worksite Health Clinics, is that employers are free to organize care as they please. The clinics are not revenue centers, and insurers are not breathing down their necks. Primary care visits can be 30 to 40 minutes rather than squeezed into 15—or less.

The clinics range in size from a nurse who shows up in a mobile unit a few hours per week to a large-scale, full-service health clinic with multiple primary care providers and clinicians who can provide dental and vision care.

Business models vary too. In some cases, employers employ or contract directly with the providers. In others, they contract with a vendor that provides the service. Vendors may be local medical groups or health systems or firms that have sprung up specifically to provide this service. The number of such vendors has grown to about 30 to 40, says David Keyt, a Mercer consultant who specializes in employer health centers. “New vendors seem to be popping up with regularity,” he says. Major players in this space include CareATC, Marathon Health, and Vera.

So if employers are directly providing care, does that cut out insurers as middlemen? Not necessarily, Boress and Keyt say. In fact, insurers have stepped in to act as vendors of providing clinic services; UnitedHealthcare piloted worksite health centers early and has expanded into providing employer-sponsored clinics with its subsidiary, Optum, buying urgent care centers. Aetna is looking to expand its footprint in the employer space with its CVS Minute Clinic affiliation, and Cigna has piloted on-site health centers for its patient population.

Moreover, most employer clinics are focused specifically on primary care. They aren’t about to replace specialty or hospital care—and the need for insurance coverage to pay for it. “Clearly the health plan is the overall umbrella of services for employers. These centers are only open during work hours,” notes Boress. “There still needs to be access to other providers.”

Insurers also remain in the loop as data processors. Even if an employer is paying directly for the services and charging employees a small copay or none at all, the visit still goes through the health plan’s claims process so the employer can keep track of the health status data that goes along with it.

Are HSAs an obstacle to on-site clinics?

Many large employers want to offer no-cost primary care visits near the workplace to make it as easy as possible for workers to get care. But high-deductible plans paired with health savings accounts may throw a wrench in those works. Employers can’t provide workers “significant medical benefits” to patients with HSAs, according to Internal Revenue Service rules. That means charging a copay for those visits. Mercer consultant David Keyt doesn’t see that as meaning companies will give up on on-site clinics, but it may give them pause. Half of respondents to the Mercer survey said they’d get better utilization of their clinic if they didn’t have to charge a copay. Legislation is pending in Congress that would clear the way for HSA holders to get free visits at a workplace clinic; HR 6199 was approved by the House in 2018 but has not yet moved in the Senate.