By PETER ROUSMANIERE, an expert on the workers' compensation industry
"I don't think there is much available studies on the effectiveness of on-site clinics," said Nico Pronk, senior research investigator of the HealthPartners Health Behavior Group in Minneapolis.
"The on-site clinic is kind of a hub to serve to integrate more researched interventions--wellness, pharmacy, primary care, clinical preventive services, overall coordination of care," said Pronk. "If the on-site clinic does not do that, I don't think that the investment is worth its money."
Pronk and fellow members of a committee on community preventive health, created by the federal Centers for Disease Control and Prevention, have been studying if corporate initiatives are worth the effort.
"We just finished a huge review of the literature on this topic. Basically, the question is if health risk assessments (completed by employees) have a significant impact on health behaviors," said Pronk.
"The outcome of that review shows 'strong evidence' of effectiveness, combined with health education programs, to reduce risk factors, number of days lost, hypertension, high cholesterol, tobacco used and dietary fat intake."
There is less solid but yet "sufficient evidence," Pronk added, that health risk assessments have the same effect on increasing belt use, changing unsatisfactory summary health status, reducing nonpreventive healthcare use, reducing excessive alcohol consumption and increasing physical activity.
The committee Pronk is on found eight studies that calculated the annual financial return from wellness programs. The returns were all positive and went from 1.4 to 1, meaning a savings of $1.40 for every $1 spent, to a ratio of 4.7 to 1.
Pronk and his colleagues at HealthPartners consult to employers.
"We have programs running where we integrate health risk appraisal, along with the completion of intervention programs, and if you the employee do that, you get, say, $250 reduction in insurance, or a reduction by $35 per visit of co-pay charges. We are seeing 95 percent to 98 percent participation in wellness programs. People really do participate in these programs. Our data shows ROI of close to 3 to 1. We see people improve their health quite dramatically in three or four years."
An insistent question pops up: why does the large American employer appear more inclined now at managing its employees' health condition than, say, 10 years ago?
Pronk's answer echoed that of others engaged in corporate promotion of employee health, namely that tools of the 1990s such as managed care failed to deliver either healthier workers or containment of costs.
There is also, Pronk added, greater recognition today about what kinds of employees really need paying attention to in terms of health risk. They are, he said, the 25 percent to 40 percent of the workforce that is not yet sick, but are at risk due to health behaviors. These workers will not be fully known by the medical establishment unless they become really sick. The point is to make sure that doesn't happen.
In any event, a strategy that uses on-site clinics to keep workers healthy is a sharp departure from the work-injury focus of the traditional industrial clinic, located on-site or just down the road. This kind of clinic's work load has been diminishing because of the long-term trend downward in the number of work injuries.
Yet the industrial clinic model still deserves respect. The payback from can be immense if they were well managed. This is according to John Banks, one of the founders of Simworks Systems, a rehabilitation firm experienced with onsite medical programs.
Banks said that Japanese auto manufacturers in the United States may have developed the on-site medical care model to the farthest degree. "They put the best physiatrists, orthopedists and neurologic specialists on-site. They get a doctor who understands industrial injuries."
"They put a physical therapist into the plant, right into the production line, for work reconditioning, exercise therapy, with cars going overhead. They keep the worker who is being treated as part of the workforce. They take their breaks with their normal workmates."
April 15, 2009
Copyright 2009© LRP Publications