Employers join forces for clinic to serve all workers
Clinic created to meet all medical needs
When a hospital and equipment manufacturer found they could not find adequate occupational health services in their rural community, they decided to open their own clinic. Neither employer could afford to open a suitable clinic on its own, so they joined forces to open a health care facility dedicated exclusively to their employees and their families.
The new center is called Employers’ Healthcare Center, in Grand Island, NE. It serves St. Francis Medical Center and New Holland North America, one of the world’s leading manufacturers of agricultural equipment, both in Grand Island. The center provides both occupational health and primary care services to the 2,000 employees of the two sponsors, plus their dependents.
An employer-sponsored occupational health center is an unusual arrangement, but it sometimes is the only way rural employers can ensure adequate health care for their workers, explains Sue Brissette, executive vice president for corporate services with Corporate Health Dimensions (CHD) in Lathan, NY. CHD is the company that contracted with the two employers to open the center and manage it.
"An arrangement like this is particularly useful in smaller settings where the employers don’t have a lot of providers to choose from," she explains. "In a more urban setting, in which there may be a number of occupational health providers to choose from, employers may not find it necessary to set up their own clinic. But in rural Nebraska, it’s hard to access any kind of health care, much less specialized care like occupational health."
A first: 2 employers share center for workers
CHD is a leading developer and manager of health centers for employers, but Brissette says the Nebraska clinic is the first she has seen co-sponsored by two employers. The 8,000 square foot center opened in October 1997 with two staff physicians, a nurse director of operations, four clinical staff, two pharmacists, two pharmacy technicians, and two receptionists. The clinic is next to the campus of St. Francis Medical Center, about two miles from New Holland, the other employer.
The Employers’ Healthcare Center is part of an enrolled health plan for the employees of both institutions, with incentives that encourage employees to choose the center for their health care. The center provides both occupational health care and a wide range of primary health care.
"It is a cost-saving approach for employers because they partner with a company who manages care for them," Brissette says. "Managed care tends to focus on large metropolitan areas, not rural areas like this with no population base. We bring our discounts and our pharmacy to this location, and our pharmacy tends to have lower pricing. Because we partner with medical staff on site, we are able to change practice patterns, such as using generics and therapeutic substitutions, to be more cost effective."
Brissette says similar health care centers can be set up in metropolitan areas, but the needs of the employers would be somewhat different and so the center design could change. In a more urban area, the center could be staffed with occupational health specialists and the competition from other providers would make that a necessity. CHD has 41 operations in 14 states, including 22 occupational health centers
In-house OH staff still needed
Providing primary care and occupational health in the same facility, with the same medical staff, improves the continuity of care for the patient, Brissette says. Both of the employers maintain in-house occupational health nurses just as they did before the center opened, so some of the primary occupational health functions were not transferred to the new center. But the center does provide a full range of physicals, testing, case management, urgent care, and workers’ compensation management.
The two staff physicians provide both the primary and occupational health care, says Michael D’Amario, executive vice president of operations in CHD’s primary care division. D’Amario and Brissette acknowledge it would be ideal to have occupational health specialists providing the occupational health care at the center, but they say it was difficult to devote a staff physician solely for that line of work. It also would be difficult to find an available occupational health specialist in rural Nebraska.
"We looked for family practice physicians, preferably with some exposure to occupational health," D’Amario says. "The medical director at the center also has access to our corporate director of occupational medicine, so there are means for obtaining that special advice. We can set up a separate occupational medicine component in any health center we open, but it’s usually a matter of volume when deciding whether that is cost effective."
CHD and the two employers determined that the volume of patients would not sustain a separate component for occupational medicine. D’Amario points out that the level of occupational health provided to the workers increased significantly when the center opened because the employers previously depended on family practice physicians for much of the care that their own in-house staff could not provide. While the center’s staff also are primary care physicians, they are working within a framework that provides all of the necessary administrative management of workers’ comp cases, routine testing, and other occupational health needs.
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