Advantages of on-site and near-site clinics

The advantages of the direct primary care that clinics offer are:

• Transparency and control over design. With the insurer “middleman” removed, plan sponsors can specify quality, access and outcome expectations directly in the agreement, including value-based elements and steerage incentives to clinic providers. Instead of being at the peril of fee-for-service vendor incentives that lead to excessive costs, plan sponsors can create compensation incentives for clinic providers, such as performance payments for reducing costs from increasing generic drug use, as well as reduced emergency room visits from non-emergencies and visits to specialists. This allows them to waive cost-sharing on preferred providers or centers of excellence and deliberately shape referral patterns and benefit design around high-value care.
• Improved participant experience. Clinics provide tighter coordination of care and faster resolution of issues, which reinforces trust and increases utilization of the highest-value network. There are no copayments for routine primary and preventive services visits.
• Access, continuity and chronic care control. There avoids the stereotypical “three-month wait” to see a primary care physician. At clinics, participants typically can schedule same-day or next-day visits with longer appointment times than at fee-for-service providers. When it is staffed correctly the clinic can also accommodate walk-in patients. The proximity of the clinic allows for an easy commute to visit a doctor when needed, as travel is not a barrier. Also, the clinic can be designed to be open on after or before work hours and on certain weekends. This can avoid or minimize certain urgent care or emergency room visits. Virtual visits are available. Easier access and stronger longitudinal relationships improve chronic disease control and preventive care, which cuts high-cost complications and stabilizes the plan sponsor’s health cost trends over time.
• Participant satisfaction. Participants have minimal or no out-of-pocket costs for primary care and can handle issues quickly without long waits or repeated urgent care visits. The high perceived value and experience support loyalty and make benefits more competitive in industries where the labor market is tight.

Because of flexible contracting and improvements in technology, the costs of setting up a clinic can be sustainable even for groups with modest numbers of participants. Moreover, near-site clinics may be shared by multiple plan sponsors, making logistics more workable and the cost more affordable for smaller groups.

How do clinics save money?

Because a clinic is sponsored by the plan, it’s a form of personalized medical care that increases patient participation and compliance with treatment.

Additional benefits are realized from the clinic staff knowing the benefit plan of the patients, by giving them personal attention and engaging them in wellness and disease-management programs. Also, proximity and a well-thought-out clinic design that provides all the necessary services under one (nearby) roof makes it more likely that patients will comply with the treatment regimens. Especially for chronic conditions, increased patient participation and compliance leads to decreased specialist referrals and visits, emergency room visits and inpatient hospitalizations over time.

There’s another reason a clinic saves money: Patients can be directed to more efficient service providers and facilities, such as facilities with direct contracting or centers of excellence providers, so the cost per unit of service is less.

Finally, significant savings can be generated for the plan sponsor if the clinic dispenses prescription medications. Clinics can obtain a lower price than is available from retail providers, and they can better monitor drug usage.

Five key factors to successful introduction of a clinic

1. Find the right vendor to operate the clinic

The clinic provider marketplace is evolving. There have been many mergers, acquisitions and exits. Consequently, it’s important to find a vendor that is financially stable and is a good cultural fit for your organization. When local health systems set up an on-site clinic, they often treat it as their community clinic or urgent-care clinic. That approach misses an opportunity to engage members in the plan’s wellness program.

It's also essential for the clinic vendor to be fully responsible for medical malpractice insurance for all of their staff and all the associated liabilities with services provided at their clinic.

2. Provide a great patient experience

Patient experience is extremely important. When you build it “right” they will come. Positive word of mouth can positively impact utilization of the clinic. More so, negative word of mouth will have a greater negative impact on clinic utilization. Patients’ opinion of the clinic is largely based on their experience with the clinic’s staff. There are many options for staffing a clinic, from a full-time physician to a nurse practitioner or a physician’s assistant. What’s most important is the cultural fit of the staff with the participants. That’s what will give patients a positive experience.

3. Create incentives for participants to use the clinic

Incentives work. There are various incentive options. Most popular is a reward to complete preventive care visits or wellness programs at the clinic. The reward might be a copayment reduction, premium differential, paid time off or giveaway items — provided they are compliant with state and federal laws.

4. Communicate with participants

Having an effective marketing and communication strategy is an important factor in a clinic’s success. All modes of communication should be used, including displaying promotional materials and sending emails about clinic events. The communication campaign should highlight logistics, such as what conditions participants can see the provider for, how to make an appointment, clinic hours, location and incentives offered. Hold an event to introduce all the clinic staff to the participants and to describe the programs and services the clinic plans to offer.

When setting up a marketing and communication strategy and communicating to participants, patient privacy is a top priority. Reassure them that the clinic adheres to all HIPAA requirements and best practices for dealing with patient concerns about privacy.

Keep in mind that communicating with participants about the clinic should be an ongoing effort.

5. Track performance

Creating performance metrics and monitoring them on a regular basis is key to making constant improvements. The clinic vendor should be held accountable for best-practice performance guarantees, such as reducing ER urgent care and specialist visits, delivering excellent customer service, ensuring compliance and reporting. Claims data can suggest improvements, such as adding physical therapy or behavioral health counseling at the clinic.

The on-site/near-site clinic model is worth considering

When administered correctly and insured appropriately, offering an on-site or near-site clinic can be a very effective strategy for managing healthcare costs. It can bring control in-house for wellness programs, for referrals to specialists and for using the right facilities.

The on-site/near-site clinic model has potential to provide a positive ROI and improve member satisfaction, which is a win-win for all.