Evolving On-Site Health Care Delivery: Innovating Beyond the Traditional Model

On-site clinics are being repositioned to meet the needs of employees in the post-COVID workplace.

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November 09, 2021

The unique circumstances created by the pandemic have led to further acceptance of remote work and increased utilization of virtual care services. This in turn has led many employers to adapt and adjust their benefit offerings, including their on-site clinic strategy.

Shifting Focus and Priorities: Pre-pandemic and Onward

Prior to the pandemic, many employers established on-site clinics at locations where they had a large concentration of employees. The clinics provided convenient access to certain health and well-being services and contributed to increased employee productivity, lower emergency room utilization and increased use of preventive care. Although some on-site offerings were scaled back during the pandemic, findings from Business Group on Health’s 2022 Large Employers’ Health Care Strategy and Plan Design Survey reveal that employers plan to reinstate on-site clinics and services as employees start to return to the workplace. Furthermore as 2021 draws to an end, some large employers have expanded the role and capabilities of their on-site clinics to meet shifting health and safety needs. By reinstating on-site clinics, employers have an opportunity to offset anticipated costs linked to delayed and deferred care during the pandemic.

Over the past 2 years, the types of services offered through on-site and near site clinics (e.g., acute care, health improvement programs, occupational health and flu shots) have expanded to include administering COVID-19 vaccines and educating employees about them. Employers also offered COVID-19 testing at on-site clinics and supported other vital physical and emotional health and safety needs that emerged during the pandemic.

Changes Implemented During the Pandemic that May Continue Beyond 2021

During the height of the pandemic, some employers extended on-site services to remote workers, using virtual care to compensate for the decreased on-site presence. Approximately 54% of large employers kept all their clinics open during the pandemic, while 26% kept only select clinic locations open.

Many employers expanded access beyond the traditional care offering. For example Land O’Lakes, Inc., working with its on-site clinic provider, pivoted its on-site clinic approach by providing more virtual care solutions for their remote workforce. Such virtual offerings included primary care, urgent care, physical therapy and behavioral health services. The company also strategically kept its on-site clinics open, offering a safe place for employees and their families to access health care during the pandemic.

For more information about Land O’Lakes’ on-site clinic strategy, members can download presentation slides from the Business Group on Health webinar, Strategies for Empowering Health and Well-being Across a Dispersed Workforce.

As virtual care has become more accepted and utilized by traditional providers, more on-site clinics also went the virtual route. Overall, 2020 to 2021 marked a 5% increase (i.e., up from 80% to 85%) in surveyed employers that believe virtual care will have a significant impact on how care is delivered in the future. For some employers, this trend may signal a reduced need for on-site care, while others will demand that on-site clinics develop virtual capabilities in order to equally support the on-site and remote workforce.

The Future of On-site Clinics

With the ever-evolving needs of today’s workforce, employers are repositioning their existing on-site clinic facilities to meet those demands. Based on the 2022 Large Employers’ Health Care Strategy and Plan Design Survey, employers are expanding on-site services to include on-site employee assistance programs (EAPs), primary care, mental health services and COVID-19 vaccinations, as well as less traditional offerings such as preventive screenings and virtual care delivery (e.g., virtual fitness classes, digital diabetes management solution, behavioral health navigators, etc.).

Mental Health Support

Employers are seeing a rise in cost and utilization trends as a result of a rising need for mental health services.1 More specifically, when surveyed, 91% of large employers affirmed that they are concerned about long-term mental health issues (e.g., depression, anxiety) exacerbated by the pandemic. Therefore, a greater number of employers are expanding beyond the traditional models and adding on-site mental health resources (especially for more at-risk and vulnerable employee populations) and—where logistically feasible—are offering virtual mental health services. Findings from the 2022 Large Employers’ Health Care Strategy and Plan Design Survey indicate that 17% of respondents expanded their mental health services at on-site clinics that remained open during the pandemic.

The pandemic, however, has also highlighted the value of virtual mental health strategies, along with the shortage of mental health providers. For these reasons, virtual mental health, which has provided better access and flexibility, will likely increase in the future.

For more in-depth information on this pertinent issue, check out our recent webinar, Everyone Needs Mental Health Care: Increasing Access Across the Workplace.

Primary Care and Preventive Screening

For many employers, one of the goals of providing an on-site clinic is to facilitate convenient care. With a shortage of primary care providers and greater organizational commitment to promoting primary care, on-site clinics could help close the gap for some types of primary care services. On-site primary care is more accessible and provides a safe and trusted environment for employees.

Having access to a primary care physician at an on-site clinic can reduce overall health care spend in a number of ways, including:

  • Managing employees with chronic conditions and ensuring they are properly redirected to any additional programs that may be available through third-party vendors;
  • Screening for mental and behavioral health issues—and then redirecting to on-site mental health care through the EAP or third-party vendors;
  • Increasing prescription drug adherence;
  • Promoting cancer screenings and facilitating biometric screenings; and
  • Providing flu shots and immunizations on-site.

Comprehensive COVID-19 Support: Vaccinations, Testing and Contact Tracing

There is an opportunity for employers to expand the role of their on-site clinic(s) in ongoing management of COVID-19 safety, which could include administration of COVID-19 vaccines, diagnostic and screening testing and supporting other evidence-based public health and safety initiatives. According to data from the 2022 Large Employers’ Health Care Strategy and Plan Design Survey, 72% of large employers with on-site clinics will offer COVID-19 vaccinations in at least one or more of their locations. In addition to COVID-19 vaccinations, the role of trusted on-site clinic staff can be vital when it comes to effectively educating on vaccine safety and the importance of remaining up to date on immunizations. In quick survey findings from March 2021, over one-third (35%) of employers surveyed shared that their communication strategy involves partnering with trusted entities in order to inform and encourage COVID-19 vaccinations among employees. In addition, more than half of employers surveyed plan to directly engage the delivery system to support COVID-19 vaccination.

With the most recent ruling issued by the White House requiring employers with more than 100 employees to ensure that employees are fully vaccinated or produce a negative COVID-19 test result on at least a weekly basis, on-site clinics can be further expanded to not only administer vaccines, but also conduct COVID-19 testing for the unvaccinated. Providing such services on-site would make access easier, increase productivity and reduce payroll costs associated with reimbursement for testing for hourly workers.

In certain cases, employers are also utilizing their on-site clinics for contact tracing for employees who have tested positive. The clinics not only help patients understand the risks associated with exposure to COVID-19 and worksite safety and quarantine protocols, but also contact the exposed individuals to ensure that they get the care they need.

Other advantages of on-site clinics that also serve to frame the business case include the following:

  • 1 | Attract talent: An effective clinic strategy can be seen as a tool to attract and retain talent that values convenient access to such services.
  • 2 | Address well-being needs: Expanding clinics in less traditional ways can potentially address other well-being needs such as financial well-being.
  • 3 | Address inequities and gaps: Ensuring diversity of providers and targeting outreach to those who are underserved can help close health equity gaps.

For more general information on the role of employers in encouraging and tracking COVID-19 vaccinations, please see the following Business Group resources: Employers' Role in the COVID-19 Vaccination Effort, Time Off & the COVID-19 Vaccine and Quick Survey Findings: Large Employers' COVID-19 Vaccine Strategy Update.

Looking Ahead

This is the time and opportunity for employers to ensure that their on-site solutions evolve and align with the ongoing evolution of the health care system itself to meet employee needs for convenient health care services. This objective can be more readily achieved through a comprehensive and integrated design of care offerings and remaining virtually savvy on innovative solutions and tools that can help meet the changing needs of diverse workforces. Moreover, it is important to consider whether on-site clinics provide access and manage health care data in a way that also drives better engagement in these services.

With so much focus on primary care, it’s important to understand the services that are being offered on-site and how they can be expanded beyond acute care needs. At the same time, it is equally important to be aware that on-site strategies can often vary based on location and the needs of employees.

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TABLE OF CONTENTS

  1. Shifting Focus and Priorities: Pre-pandemic and Onward
  2. Changes Implemented During the Pandemic that May Continue Beyond 2021
  3. The Future of On-site Clinics
  4. Looking Ahead