Medical Cost Trend: Behind the numbers 2020
PwC Health Research Institute (HRI)
Condensed and presented by Advanced Plan for Health
The Advanced Plan for Health team regularly scans the health market for trends, analysis and insight. In our research, we found The PwC HRI Medical Cost Trend: Behind the Numbers 2020 report to be full of valuable healthcare market information and thought our readers would benefit from the report findings. We decided to condense and present the PwC HRI report in a bi-weekly blog series to highlight what we found to be most pertinent to our readers and to better understand factors that could potentially affect the 2020 medical cost trend. Below is Session #6: Employers will continue to open more expansive worksite clinics, per the PwC Health Research Institute (HRI) report.
Session #6: Employers will continue to open more expansive worksite clinics
Dating back as early as the 1860s, worksite health clinics have flourished and fizzled over the course of 160 years, as employers have invested in them in bull markets and abandoned them during economic downturns.71 These clinics have been found to reduce the cost to deliver care, decrease absenteeism and improve productivity.72 Kaiser Permanente was even born out of a worksite clinic, established during World War II when Henry J. Kaiser brought physicians to employees working in the city’s shipyards to keep them healthy and productive.73 Worksite clinics are growing in number, and now there is evidence that many large and some midsize employers are doubling down on them to help prevent disease and drive more appropriate care utilization by employees. “People spend 40-plus hours a week at work. If you are going to improve health, the worksite is a great place to do it,” said Emily Fisher Moore, health and wellness principal program manager at Genentech, in an interview with HRI. HRI expects these clinics will deflate medical cost trend in 2020.
Employers are seeing the opportunity in worksite clinics, especially large employers with 5,000 employees or more. PwC’s Health and Well-being Touchstone survey found that 38 percent of large employers offered an onsite health clinic in 2019, up from the 27 percent that offered a clinic in 2014. An additional 13 percent said they were considering adding one.74 Amazon, Apple and Tesla all opened clinics in 2018.75
Worksite clinics are expanding beyond occupational medicine into primary care, preventive medicine, behavioral health services and alternative medicine. Thirty-six percent of consumers surveyed by HRI who have access to a worksite clinic said that the clinic offers an annual preventive health exam (see Figure 12).
“Primary care is often thought about as binary: You’re either healthy or sick,” said Dr. Raj Behal, chief quality officer at One Medical, in an interview with HRI. “It’s not a binary state, it’s a continuum. The space between health and sickness is where future costs develop if not managed correctly. Worksite clinics provide employers with the chance to manage these costs, keep people out of the ER and prevent chronic diseases.” One Medical has relationships with nearly 4,000 midsize and large employers, providing a “home base” with holistic direct primary care and digital health services near the workplace.76
Oklahoma City-based Devon Energy, which consistently beat national medical inflation trends over the last few years, attributes this result in part to its worksite clinic led by OU Medicine physicians.77 The company’s 1,200 corporate employees and their families have quick access to urgent care, preventive care and chronic condition management services through the clinic. Retirees also have access. Satisfaction is high, said Colleen Dame, manager of compensation and benefits at Devon Energy, in a PwC-hosted webinar. Use of the clinic by Devon Energy employees skews toward primary care versus costlier specialty care. Preventive screening compliance is above industry benchmarks, Dame said. “We’re screening and finding things that people didn’t know about,” she said. “Without that interaction with our clinic, they wouldn’t have known what they needed to change to improve their health.”
With a focus on lifestyle medicine, Genentech’s 10,000-square-foot clinic has an extensive mix of services that integrate primary care and alternative medicine provided by acupuncturists and chiropractors.78 The clinic includes space for health counseling, where nutritionists, therapists and health coaches work together, and also offers a range of other services including allergy shots, physical therapy, mental health services, STD screenings and women’s health services.79
Some companies have even integrated medical specialty care into their worksite clinics based on the needs of their employees. Staff at New York-based Goldman Sachs have access to rotating specialists ranging from dermatologists and gynecologists to rehabilitation medicine doctors.80
Source: PwC Health Research Institute consumer survey, spring 2019
With all that is stated in this recap concerning worksite clinics, each employer needs access to data that will allow them to determine the unique inflators and deflators that are driving their cost trend. In turn this will enable the development of strategies that provide a path to intervene at the point of risk and mitigate its impact, e.g. benefit design considerations, care management effectiveness, and others. To learn more about this research, feel free to contact us here.
PwC HRI Sources
(71) Paladina Health, “Onsite clinics 2.0,” February 2016, https://www.paladinahealth.com/form/download-onsite-clinics-20-white-paper.
(72) National Association of Worksite Health Centers, “Onsite clinics are a key component to a successful health benefits strategy,” Jan. 6, 2015, https://www.nawhc.org/NAWHC-NOW/6977556.
(73) Kaiser Permanente, “The Permanente Richmond Field Hospital—proud reminder of health care’s role in World War II,” April 17, 2017, https://about.kaiserpermanente.org/our-story/our-history/the-permanente-richmond-fieldhospital-proud-reminder-of-health-).
(74) PwC Health and Well-being Touchstone surveys, 2014 and 2019.
(75) Erin Dietsche, “Report: Amazon intends to open primary care clinics for Seattle workers,” MedCityNews, Aug. 10, 2018, https://medcitynews.com/2018/08/report-amazon-clinics-seattle/; Erin Dietsche, “Should Apple’s medical clinics make hospitals quiver in their boots?” MedCityNews, Dec. 6, 2018, https://medcitynews.com/2018/12/applemedical-clinics-hospitals/; Christina Farr, “Elon Musk says Tesla now has a health clinic for employees that provides ‘first-class’ service,” CNBC, Oct. 24, 2018, https://www.cnbc.com/2018/10/24/musk-says-tesla-has-a-first-classhealth-clinic-for-employees.html.
(76) PwC Health Research Institute interview with John Jackson, vice president of enterprise services at One Medical, Dr. Raj Behal, chief quality officer at One Medical, and Kristina Skinner, director of communications at One Medical, on April 23, 2019.
(77) PwC’s Disruptive Innovators in Employee Benefits webcast on April 9, 2019; PwC Health Research Institute interview with Colleen Dame, benefits and wellness manager at Devon Energy, on May 15, 2019.
(78) PwC Health Research Institute interview with Anne Marie Tsolinas, senior manager of health and wellness at Genentech, and Emily Fisher Moore, health and wellness principal program manager at Genentech, on May 3, 2019.
(79) National Institutes of Health, “Your guide to lowering your cholesterol with TLC,” December 2005, https://www.nhlbi.nih.gov/files/docs/public/heart/chol_tlc.pdf.
(80)Lucette Lagnado, “Walk-in doctor visits at work? Welcome to the office health center,” The Wall Street Journal, Jan. 8, 2018, https://www.wsj.com/articles/walk-in-doctor-visits-at-work-welcome-to-the-office-healthcenter-1515420543.