The additional time has changed the way he practices medicine.

“You have more time to think about each individual problem the patient has,” said Krause, a family-practice physician. “It allows you to slow down your whole thinking process, so that you are more thorough.”

Krause’s new practice is at Kohl’s Wellness Center, a family-practice clinic less than a half a mile from the company’s corporate headquarters in Menomonee Falls.

The clinic, which opened in July, is one of at least eight in Wisconsin run by companies. It also is part of a growing trend in which large companies try to rein in rising health care costs by providing the care themselves.

Many of those companies - including Quad/Graphics, one of the first to set up its own clinics - have shown that they can provide better care at a lower overall cost.

They’ve done that partly by focusing on primary care and prevention.

Their experience supports the contention of health care economists and analysts that the system’s focus on costly specialty care and procedures is one of the key reasons that the United States spends far more than other industrialized nations on health care.

Other Wisconsin companies that have set up primary care clinics for employees and family members include Miller Brewing Co., Briggs & Stratton Corp., InSinkErator, S.C. Johnson and Mercury Marine.

Employees can still see other doctors in their health plans’ networks. But Kohl’s and most large companies self-insure, paying most of the medical bills of employees and their families. That means the potential savings from the clinics goes to the companies’ bottom line.

In a recent survey, Watson Wyatt Worldwide, a benefits consulting company, found that 23% of over 600 companies, nearly all of them large employers, had their own clinics. Most of those clinics focused on wellness or provided only urgent care.

But more companies - among them Toyota Motor, Perdue, Sprint Nextel and Qualcomm - have set up clinics that offer a full range of services.

“There’s a lot of work upfront, but there’s a lot of payoff on the back end,” said Mitch Santiago, a senior consultant with Watson Wyatt Worldwide.

Primary care model

Quad/Graphics, which opened its first clinic in 1990, has shown that. Its employees are hospitalized less frequently and for less time than the national averages, the company says. And it estimates that its health care costs are about 20% lower than the national average.

The company, based in Sussex, sees over 18,000 patients a year at its five clinics. It also operates two dental clinics, two optical centers and six rehabilitation centers, with a seventh opening soon.

Quad/Graphics realized that it couldn’t change the health care system, said Len Quadracci, a nephrologist and president of QuadMed, the subsidiary that oversees the clinics. So the company set out to build its own model.

The model, focused on primary care, links doctors’ wages to meeting certain benchmarks of quality rather than the number of patients they see or the number of tests and procedures they do.

That isn’t the norm in the health care system. The relatively low fees paid to primary care doctors - who can make less than half of what some specialists make - means they must see more patients to maintain their incomes.

That means spending less time with patients. The result can be more office visits, more referrals to costly specialists and often lower quality care.

“It’s a system that fosters waste and poor quality,” Quadracci said.

Quadracci, who was on the faculty of the University of Washington for 20 years, returned to Wisconsin in 1995 to oversee QuadMed. The subsidiary now employs 247 people, including 33 full-time and part-time doctors.

QuadMed also runs clinics for Miller Brewing and Briggs & Stratton.

“We are not knocking on doors,” Quadracci said. “Mainly it is people coming to us.”

Appeal of convenience

The new Kohl’s clinic - bright, spacious, calm - has four examination rooms and a larger treatment room.

It has a digital X-ray machine, lab and computer system designed by GE Healthcare for electronic health records. Physical therapy is down the hall. A pharmacy is next door.

In all, Kohl’s spent $5 million to build the clinic and a new day care center.

The clinic is staffed by a doctor, a nurse practitioner, a full-time physical therapist, three registered nurses, including one who specializes in disease management, a full-time X-ray technician and other support staff.

Kohl’s contracts with Whole Health Management, a company based in Cleveland that staffs on-site clinics for such companies as Harrah’s Entertainment, Florida Power & Light Co. and Qualcomm.

The clinic is available to the roughly 3,400 employees in the corporate office and 300 employees in the company’s distribution center as well as family members who are older than 2. The cost is $10 if covered by a company health plan and $30 if uninsured.

The clinic - open five days a week - took off from the start. “The first week, it was as busy as I ever was in private practice,” said Krause, the clinic’s physician.

Part of the appeal is the convenience.

“I was able to go to one place to get everything done,” said Chris Seeber, a Kohl’s employee. A recent physical at the clinic lasted an hour and included Krause going over her medical history. “He’s been able to just sit down and talk to me,” she said.

Krause also went through the resources available at the clinic, mentioning that she could follow up with another member of the staff for information on staying healthy. He does that with each patient, encouraging them to think about their overall health, such as losing a few pounds or exercising more.

In private practice, he often raced from one task to another. “You were just trying to keep your head above the water,” said Krause, who returned to his hometown from Louisville, Ky., where he was in a small practice.

More efficient care

Kohl’s doesn’t expect the clinic to generate large savings from the start. And some of the potential savings will be hard to measure. The convenience of the clinic, for instance, should increase productivity.

It also will help employees balance the demands of work and their personal lives, said Telvin Jeffries, Kohl’s executive vice president of human resources. But the clinic also could provide more efficient - and less costly - care.

A doctor who sees a patient with a bad back might schedule an X-ray, followed by a second appointment and then physical therapy. That can all be done at Kohl’s Wellness Center.

The company also should save money on fewer referrals to specialists. And it is almost certain to save money on tests, X-rays and physical therapy by eliminating the mark-up.

The savings aren’t immediate. But Quad/Graphics and other companies have shown that they can be real.

They also have shown that putting more emphasis on primary care - and changing the incentives that exist in the current system - could make the health care system more efficient.

“This is what patients want, this is what they are looking for,” Krause said. “But because of the economics of medicine, they are not getting it.”

Source: JS Online
Original Publication Date: October 7, 2007