It always feels funny, she said, laughing, as medical assistant Nadine Slaughter listened on the other end. Slaughter pumped up the compression sleeve around Angel’s arm, then let the air out to check her blood pressure.

Angel’s afternoon appointment was a sports physical for cheerleading. Her mother, Abigail, waited outside, but she wasn’t far from work. The clinic, sponsored by her employer, Symmetry Medical Inc., is in leased space across the street from its Warsaw-based instrument production plant.

A single mother of three daughters, Abigail Bruce likes that her family’s care is free through the employer-sponsored clinic. She also gets some free medications, including a smoking-cessation drug.

Symmetry announced in April that it’s offering employer-sponsored health care through the clinic in Warsaw to about 500 employees in its Warsaw and Claypool operations. The employees’ dependents are also covered. Symmetry joined a growing legion of larger employers that have opened on-site clinics with goals of improving employee health and morale, increasing productivity and cutting health care costs. On-site clinics vary. Some offer basic services; others are occupational health centers providing treatment for work-related injuries. Still others are more comprehensive clinics that offer services akin to the family doctor, such as Symmetry’s clinic.

Symmetry has contracted with Novia CareClinics – an Indianapolis-based company that operates 10 clinics for nine employers throughout the state – to manage its clinic.

On-site clinics have their limitations – namely hours. Dr. Craig Nadelson, Novia’s medical director, recommends patients maintain relationships with their family physician for medical consultations during off hours. There’s also concern that employers may access employee health information for employment decisions.

But employers are emphatic that they aren’t accessing medical records and point out that employees are protected by the same privacy laws governing any medical office. They tout advantages for employees including savings, convenience and more face time with doctors. And employees typically have other options, including their family doctor, if they don’t wish to use on-site clinics.

Symmetry hasn’t changed its insurance policies since unveiling the clinic – a voluntary offering for employees – so employees are free to go wherever they choose for medical care, company officials said.

Abigail Bruce said she liked the time her doctor spent with her: visits are scheduled for 20 minutes; initial consultations can last 40. “I think it’s amazing,” she said.

The most reaffirming part for employers is the good will from employees who sense their employer cares for their health, said John Asencio of Sibson Consulting, the human-resources consulting division of The Segal Co. in New York. He’s seen renewed interest in on-site health centers.

Companies are “looking for ways to control the cost of health care and to manage the productivity of their workforce,” he said.

Asencio didn’t have any industrywide numbers and was not aware of any trade association that tracks employer-sponsored clinics. Based on anecdotal evidence, he believes clinic numbers have increased over the past five to seven years. Though growth “has flattened out a little bit over the last 12 to 18 months,” he thinks the number of on-site clinics will increase.

As far back as the first half of the 20th century, companies employed staff doctors, particularly in manufacturing settings where injuries on the job could affect productivity. That practice declined when staff doctors became a liability for many companies, Asencio said.

Today, most companies with on-site clinics contract with outside firms to provide on-site health care services. Some clinics are staffed by nurse practitioners and treat minor ailments, tasks similar to retail clinics’ duties. Others – such as Symmetry’s clinic, which is staffed by two doctors and a nurse practitioner – offer primary care, preventive care and lab services.

But not all employees embrace the clinics.

The perception by some employees that employers could get into their medical records “is a problem,” said Lanny Green, one of the principles and vice president of Novia. The company stresses that all medical records are kept private when it meets with employees before establishing new clinics.

“The employers have no access to those records,” Green said.

Still, just the proximity of the clinic to the workplace makes complete anonymity hard to come by, according to a professor and co-director of the Center for Law and Health at Indiana University-Indianapolis School of Law.

“You can’t have perfect confidentiality with clinics in the workplace,” David Orentlicher said.

He doesn’t dispute that patient records would be kept confidential, though aggregate health data may be shared with an employer. But he thinks employees who go to an on-site clinic are more likely to get noticed by others at the company than if they were to go off-site, he said.

“So there are risks” associated with on-site clinics, Orentlicher said. Still “it can be done in an appropriate way and for the benefit of employees.”

Providing employees with other options to seek care and using an outside firm to run the clinics are two measures employers can take manage privacy risk. He lauded Symmetry for doing both.

Company officials stressed that the program is entirely voluntary and that all patient information is held privately and kept out of company hands. Early success with its clinic has led the company to extend visit hours.

“Our primary objective is to improve the lifestyle and the health benefits of the employees, but we do expect to get a savings,” said Barry Parker, senior vice president of marketing design and development at Symmetry.

“We have routinely seen double-digit (percentage) growth in our health care costs,” said Parker, a trend he hopes to see offset. More than once, it’s exceeded 25 percent, he said, declining to disclose figures.

About a year ago, Elkhart County opened two Novia CareClinics – one in Goshen and one in Elkhart – for government employees.

The effect on the county’s medical costs is still undetermined, said Floyd Hindbaugh, director of personnel and insurance.

The county spent about $300,000 on the clinic program during its first full year. And it plans to allot $5.73 million for group insurance in fiscal 2008, pending state budget approval, up 16 percent from $4.93 million from fiscal 2007.

But pharmaceutical costs dropped to $1.39 million for the fiscal year, which ended in May, down nearly 9 percent from $1.5 million the previous fiscal year. That’s a big change from average annual increases of 10 percent to 14 percent, Hindbaugh said.

The county employs about 900 employees who are projected to save $138,500 on medical and prescription costs related to co-insurance and deductibles, Hindbaugh said. That averages out to about $150 per employee.

Novia CareClinics carry an inventory of generic medications from standard antibiotics to blood-pressure medication employees can get for free with a clinic physician’s order. Employers pay less for the drugs than they would through their employee plans, Lanny Green said.

Although it’s hard to track productivity, Hindbaugh believes quicker trips to the clinic means less work time missed. And he likes that physicians talk to patients about the big picture, including preventive health care.

Novia packages its on-site clinic services with wellness coaching – including follow-up phone calls on everything from smoking cessation to diabetes management – and a 24-hour nurse-staffed emergency triage line. Callers talk to a nurse who offers guidance on what steps they should take to address a health problem, ncluding popping an aspirin and calling back in an hour or hanging up the phone and calling 911, Green said.

Source: JournalGazette.com
Original Publication Date: June 8, 2008