Retail health clinics offer convenience and lower costs. Worksite health clinics similarly offer convenience and may save on health costs, but they also can enhance worker productivity and job satisfaction, the value of which is harder to measure. A recent article by Towers Watson focuses on the performance of an onsite health clinic at BP America’s headquarters location, which has about 10,000 employees and contractors. (TW Paper) Like most employers, BP America encourages use of the clinic by dramatically lowering employee cost-sharing for services received at the center. The particular center that BP built is very full-service, many others are fairly minimal. BP’s not only had some basic primary care, but had 24 full-time staff who offered pediatric care, lab and radiology, vision and dental services, physical and occupational therapy and employee assistance program staff. There is also an onsite pharmacy. One nurse was dedicated to disease management programs. So this was an expensive center that would have to create substantial savings to generate a return on a health cost basis alone. Over the first 18 months about 56% of employees used the clinic on at least occasion. This is pretty impressive considering that the center had to persuade people to disrupt existing care routines.
The employees using the center appeared to be slightly less healthy than the rest of the BP population. After the clinic opened, their rate of primary care visits went up 25% in the following year, and specialist visits went up 12%. Surprisingly, ER use was up 18% and outpatient hospital visits increased 14%. The only category of care that didn’t increase was inpatient, which was flat. All this increased utilization could just reflect undiagnosed disease, or deferred care that was used at the center because of the lower cost-sharing. These utilization rates were higher than for the BP employee base in other locations and in some cases, like primary care and specialty visits, a general Houston benchmark, but inpatient use and ER use was lower than for that benchmark group. The good news may be that the center is providing a source of relatively inexpensive, ongoing care for people with chronic conditions. The bad news may be that the convenience of the clinic is raising utilization. It is too early to make a solid judgment, but the center at least seems to have the potential to have lower per patient spending on a health-adjusted basis. A rudimentary ROI analysis, however, suggests that the center costs slightly more than it may be saving, but that too may improve over time.