Does an on-site clinic make solid business sense in today’s marketplace? Navigation Insider sat down for a conversation with the medical center leaders at Ohio-based industrial metals manufacturer Worthington Industries.
A recent Business Group on Health survey found that 72% of large employers have an on-site clinic or are considering one by 2023. That means many business owners, investors and HR teams are discovering — or intend to explore — the value of delivering healthcare and wellness services directly.
Worthington Industries, a Quantum Health client, opened its medical and wellness center in 1995. Navigation Insider spoke with Dr. Bill Gegas, medical director, and David Cowden, manager of medical center administration, to get their perspectives on Worthington’s long-standing, hands-on approach to healthcare.
Scope of services and staffing
Worthington employs more than 10,000 people across 53 facilities in six countries. Its 14,000-square-foot center serves about 1,400 employees and retirees (plus their families) who live and work in Central Ohio.
With 26 full-time staff, including nurses, pharmacists and the equivalent of 2.5 family doctors, the center provides what Gegas describes as “80% of the medical care needed by our patients.” Core services span physicals and wellness screenings, hearing tests, women’s health, immunizations, treatment of lacerations and other injuries, and preadmission testing for surgeries.
Interestingly, occupational medicine accounts for a small percentage of center services, an indication of the company’s safety-focused workplace. Meanwhile, patient visits in volume are driven by an array of ancillary and wellness services. Those include chiropractic care, therapeutic massage, behavioral health and nutrition counseling, all provided by part-time therapists and specialists.
The center’s lab is certified to perform several tests in-house, including pregnancy, mononucleosis and COVID-19. An on-site pharmacy (and its dispensing robot, Kirby) fills about 40% of the prescriptions written for Worthington employees and their dependents, with half of those fills delivered via mail to 24 states.
Breaking down barriers to care
Gegas, Worthington’s medical director since 2000, credits company founder John H. McConnell as the center’s visionary. “He deeply cared about employees and their families. I think he recognized that cost and access were barriers to healthcare. He wanted a medical center on the grounds, so employees could have immediate access to affordable care if they needed it.”
To keep care convenient, the center strives to take same-day appointments and conducts time tests to confirm that its average wait to see a doctor stays below 10 minutes. Cowden tells employees, “This is the only medical center you’ll ever visit where you’ll spend less time in the waiting room than you will face-to-face with the doctor.”
To engage employees around the country in its wellness program, the company routinely sends nurses on the road to do diabetes screenings, blood pressure checks and vaccinations. More recently, most one-on-one reviews of screening results and healthy lifestyle behaviors take place via teleconference.
Gegas considers convenience, which promotes consistency of preventive care, a key factor in Worthington employees usually ranking below risk benchmarks for diabetes, coronary artery disease and other conditions. “If you do the screenings and have the conversations year after year, there’s demonstrable benefit,” he said. “Our goal is to provide the full breadth of family medicine, with an emphasis on efficiency and continuity.”
The economics of on-site healthcare
In early years, the center charged a maximum out-of-pocket fee of $15 for an office visit and $10 for lab work. With passage of the Affordable Care Act in 2010, Worthington could no longer provide care at such a discounted rate without employees facing tax liability.
Today, the center’s fee schedule is at 80% of Medicare rates and about a 16% discount compared with a typical family practice. Employees on the company’s most popular health plan still don’t have a copay. Prescriptions, lab tests and vaccines are provided at cost.
Cowden said keeping fees affordable, while still generating income to more than offset operating expenses, requires efficient management and staffing, plus effective negotiation with vendors. For example, unlike a small family practice, the center saves on malpractice insurance by leveraging the purchasing power of a multinational corporation.
Gegas and Cowden believe on-site healthcare has a positive impact on business factors such as employee absenteeism and productivity, but those metrics defy quantification. Instead, purely from a cost-benefit standpoint, Gegas said, “We can tell you down to the penny the value of services we provide and the expenses. The medical center generates more in savings for Worthington than the expenses associated with the center.”
Patient engagement and follow-up
Like any family practice, the center refers many of its patients to specialists for treatment and procedures. A major difference, Gegas said, is the follow-up his staff members do to ensure appointments are kept and care is received. “We keep a log of patients who’ve been referred out, and we take ownership of making sure those referrals get scheduled and are completed,” he said.
While center staff act as stewards of care for 1,400 employees and their families, those efforts are mirrored by Quantum Health, providing healthcare navigation and care coordination to nearly 12,000 members enrolled in Worthington’s health benefits. Gegas said proactive engagement and care coordination by Quantum Health play important roles as Worthington strives to close care gaps and improve health outcomes across its workforce.
“The American system of medicine is confusing and complex,” he said. “With Quantum Health, our employees have a point of contact they can trust who will provide continuity for their healthcare or benefits issues and be their advocate to facilitate resolution. I think that’s a distinct advantage.”
How healthcare navigation and care coordination support Worthington’s clinical strategy
Worthington’s HR team works closely with Quantum Health on such ongoing strategies as engaging chronic-condition plan members and doing concurrent review on inpatient hospital admissions. They also recently awarded Quantum Health with management of the company’s wellness program, from one-one-one coaching to incentive-awards fulfillment.
Most of Gegas’ interactions with Quantum Health tend to be around specific cases. For example, he considers it valuable to patients and the company when complex cancer cases get a second, expert opinion through Quantum Health’s Personal Precision Oncology Management service. He also recalls a case where Quantum Health’s clinical review and price negotiation around specialty drug authorizations helped Worthington save hundreds of thousands of dollars on a remarkably effective, but highly expensive, single-dose treatment for a patient’s rare central nervous system disorder.
“Philosophically, Quantum Health aligns with what we’re trying to do in terms of quality and efficiency of care,” Gegas said. “They understand the level of advocacy we want them to provide, and they meet that expectation in the service they give to our employees across the country.”