Clinical Innovations - Health Care at the Work-Site as a Major Innovation

Another Way for Resolving The Clash of Cultures between Managers and Professionals and Reducing Costs

“As a manager of professionals, how often in your career have you had to confront attempts by your professional associates or subordinates to challenge your authority? As a professional, how much longer can you put up with managers who interfere with your right to work autonomously?"

Joseph A. Raelin, The Clash of Cultures: Managers and Professionals, Harvard Business School Press, 1986

One of this blog’s purposes is to acquaint readers with powerful new innovative trends – those with “legs” strong enough to transform health care. In recent years, those trends have included consumer-driven care with its step-children – HSAs, high deductible health plans, retail clinics, and now a new kid on the block – work-site health care.

In one way or another, most major developments in health care have two purposes,

•To resolve conflicts between managers of corporations and independent physicians in order to contain costs, expand access, and improve care. Those conflicts led to the managed care movement – with HMOs serving as intermediaries to bring doctors to heel. Because of rebellions by patients and doctors, managed care largely failed.

•To find organizational models that would achieve these same ends. To date, the most effective models have been physician-led private and academic multispecialty groups and integrated hospital-based health systems with administrators (often physician leaders) and salaried physicians working in tandem.

For the most part, these developments have failed to resolve the authority and cost issues at the workplace. Corporations are hemorrhaging from health benefit costs -- and are desperately seeking solutions – solutions to protect employees’ health, retain employee loyalty, and save costs.

This is where CHD Meridian Health care, a medical management company enters the picture. It proclaims it is a champion of “employer-sponsored care.“ Meridian is a Nashville- based medical management company whose services are designed to provide cost-effective medical outcomes for large employers and their employee, retiree, and dependent populations. CHD Meridian is a managed care and managed cost provider.

The company designs, builds, staffs, and manages employer-sponsored health care work sites offering health care services directly to a company's covered population. Information systems within these sites communicate with existing pharmacy benefit management (PBM) vendors, as well as monitor employees, retirees, and their dependents. CHD Meridian currently provides employer-dedicated services at the worksite to 225 clients.

These services feature work site clinics conducted by salaried primary care physicians and nurses. Employees have direct access to care for workplace illnesses or injuries, chronic disease programs, occupational medicine care, generic drug prescriptions, lab work, physical therapy services – mostly free of charge or at markedly reduced rates. Clients include GE, Toyota, and other Fortune 1000 companies. Savings to date amount to about 20 to 25 percent of benefits costs.

It takes an employment base of about 1700 employees to make these clinics work. Employee coalitions can also avail themselves of these services. This approach reduces acute care expenses, takes care of low risk problems, and helps retain employees. Furthermore, it gives employers tight control of costs, partly because doctors are working on salary have no incentives to provide excess services.
Employer-sponsored health care was pioneered to enable large employers, mid-sized employers, and consortia to directly contract for primary care and pharmacy benefits - and to realize significant savings - without disrupting existing managed care or pharmacy benefit management plans.

Direct contracting reduces costs while improving access and quality of care. CHD Meridian was the first employer-sponsored health care provider to achieve accreditation by the Accreditation Association of Ambulatory Healthcare (AAAHC).

Will work-site health clinics resolve the nation’s health cost and access crisis? Of course not, but these clinics show convenient, lower-cost, consumer-oriented care can effectively be delivered where employers work. And, along with retail clinics, they’re an example of innovative organizational restructuring, outside the usual ambulatory health care settings.