Driving Employee Wellness Programs with Health Clinic Services

From Patient Engagement HIT

By Sara Heath

In between trips to the water cooler and the copy machine, employees at BAE Systems can get a strep test, right on site at the in-office health clinic. This employee wellness program has helped BAE Systems deliver elements of primary care and health clinic services straight to its workers, driving productivity and convenient access to medical care.

The wellness program, in which BAE Systems partners with health clinic provider Marathon Health, has resulted in a win-win situation for both patients and employer. The program has resulted in better engagement, access to healthcare, and lower healthcare costs.

Supporting these wellness services was all a part of BAE Systems’ effort to reduce healthcare spending for itself and its employees, according to Kevin Robinson, the company’s wellness coordinator.

“In the mid- to late-2000s, we were seeing double digit increases in our healthcare premiums every year,” Robinson told PatientEngagementHIT.com. “We wanted to improve the health of our employees to get them healthier. We started with just health assessments and onsite wellness coaching through a registered nurse in 2006 or 2007.”

But even after implementing on-site health assessments, Robinson and his wellness team continued to see growing medical claims across the company. Employees were still heavy users of off-site medical services because they were at high-risk for developing medical complications or chronic illness.

Robinson and his team tapped Marathon Health to provide BAE with an acute care option that was outside of the insurance-based system.

Currently, Marathon Health has set up shop in BAE Systems’ Kingsport, Tennessee office. Patients can access acute care services, medication dispensing, health screenings for employee spouses and children, health coaching, and occupational health services and screening (i.e. asbestos testing) all within their workspace.

Employees do not present their health insurance cards at the in-office clinic, and the visit isn’t issued as a payer claim. The operation is completely controlled through Marathon Health and BAE, with BAE paying a flat annual fee for the entire program.

Although the Marathon Health sites are framed as acute care health clinics, providers aim to improve patient wellness beyond the acute care need.

Even when a patient presents with a sore throat or stuffy nose, Marathon Health providers are focused on understanding the root causes of health issues to promote better wellness and to prevent developing chronic conditions, according to Marathon Health Clinical Lead Sasha Loffredo, MD.

“We try to identify stressors in patient lives that we could address, including risk factors,” Loffredo said in an interview with PatientEngagementHIT.com. “We try to engage them in health and wellness at every encounter so that it’s not just taking care of the acute complaint.”

“It’s like a mini-health system that’s focused on prevention and lifestyle and all these things that are really important to improving the health status of our communities.”

The in-office clinic model thrives off of a high convenience factor, Robinson explained.

“Instead of having to go to an urgent care clinic and a pharmacy if they have a sore throat, they can just come to the on-site clinic for that acute care issue and be in and out of the door within 15 or 20 minutes,” he said.

Patients can nearly always schedule same-day appointments at the in-office clinic, with little to no wait time, Loffredo stated. The clinic typically does not accept walk-ins, with occupational injuries such as a cut finger being the exceptions.

Requiring patients to schedule all of their appointments allows Marathon Health to keep their wait times short. Providers following a set schedule can better predict when the patient will show up and keep on an efficient pace.

“You’re not going to have to wait a long time to see the provider and you’re going to get seen pretty much at your appointment time,” Loffredo noted. “We want all of our patients to schedule appointments because we really respect that appointment time. You’re not going to show up and have a 30-minute wait for your visit in the waiting room.”

Having in-office and in-person consults has also improved outcomes, Robinson said. As telehealth services continue to grow in prominence, some employers are considering the technology as a way to drive employee wellness from the convenience of the office. BAE’s healthcare payer, Cigna, even presented telehealth as a convenient care offer, Robinson said.

But the face-to-face interaction during Marathon Health visits has had a positive effect on BAE employees, he noted. The allure of personalized care encounters factored into Robinson’s decision to team up with Marathon Health back in 2010.

“The research we did back in 2010 indicated that patients would get better results through face-to-face health coaching because patients get that personal aspect of it. They form a relationship with their health coach,” Robinson explained.

Anecdotally, high-risk BAE employees who are high utilizers of the health coaching services have said they enjoy the in-person interactions, Robinson reported.

Statistically, Robinson found that the approach has effectively engaged patients in the employee wellness program. Ninety-one percent of employees use at least the annual health screenings through the clinic, if not more of the clinic’s acute care services. Eighty percent of employee spouses use the annual health screenings as well.

This has driven the 100 percent engagement rate BAE has with its overarching employee wellness efforts, which also include an in-facility gym and recreational basketball and softball leagues.

The in-office clinic visits have had another positive effect, Robinson said – noticeable return on investment for both BAE Systems and its employees.

“It’s helped to keep our healthcare costs down, not only for BAE Systems the company, but also for the employees,” Robinson stated. “For five years in a row our employees saw no increases in healthcare premiums. The reductions in medical claims just by having a health clinic on-site has also saved money for BAE Systems. It’s been a win-win for the company and the employee.”

In total, BAE has saved $2.70 for every $1 it spends on Marathon Health.

These savings don’t only result from fewer health payer claims, Robinson said. Using several different algorithms, he and his wellness team can determine that on-site health clinics reduce health risk factors and the likelihood that an employee will need a more extensive medical intervention down the road.

This level of prevention is successful because clinic practitioners – primarily nurse practitioners and physician’s assistants – view the patient holistically, Loffredo said. Providers do not view the patient as simply that immediate, acute health concern.

Of course, there are still hurdles to overcome. Patients still have their own in-network primary care providers, and continuity of care can be a concern.

“We understand some employees have a very good relationship with their primary care physician, so, we encourage those employees to discuss wellness and health and lifestyle changes when they go to their primary care physician as well,” Robinson stated. “Patients must touch base with them as well.”

As health technology matures and interoperability inches closer to a reality, there may be better options for supporting continuity of care between healthcare clinics and primary care providers.

In the end, this endeavor succeeded because BAE and Marathon Health saw it as a project in overall patient wellness. By tending to downstream health needs in tandem with acute care needs, BAE was able to support patient health and improve outcomes.