About the same time it was trying to find a way to work with employers, Prevea Health was becoming increasingly frustrated that the improvements made by its automated outreach had hit a plateau. After some departmental audits, the group concluded that when patients were in front of the doctor, they did the right thing. Knowing that noncompliance in a chronic care patient could be costly—not only to the patient’s health, but also to the employer in lost time and higher insurance premiums—Prevea Health offered large, local employers the opportunity for an on-site clinic.
Ten local employers have a Prevea Health clinic. “The employers spend less on care; they just spend it with us,” he says. “It is the right thing to do for the patient because they can get in to see their healthcare provider easily, and we don’t have to cost shift to our best-paying customers.”
The on-site clinic’s primary care physicians help with occupational medicine as well as health risk assessments and chronic-care treatment. The start-up costs are minimal, under $15,000 per site, says Rai. They require a room in the employer’s building, which the practice outfits with the proper equipment, including an EMR. The clinics, which operate out of large and small manufacturing plants, can do physical therapy and lab work, and the physician sees two to four patients an hour. Aside from the use of the on-site room, the only cost to the employer is the hourly rate of the physician or APNP. At the end of the month, the employer is sent an ROI spreadsheet of how many dollars it saved—some have saved as much as $250,000 annually. “It’s a hard-cost analysis, too. It doesn’t even get into the soft savings, such as the number of missed work hours saved,” he adds.
Rai says although there is no margin from the clinics, the practice finds the ROI downstream through patient volume. Between the automated system scheduling patients and the on-site clinics, as well as geographic expansion and adding providers, in the past two years the group practice has grown its provider base by a third, and it collected about $150 million a year in revenue (not including ancillaries that are transferred to its hospital partners). The increased revenue has more than covered the practice’s cost outlay.
“We underestimated how much volume there would be … if I were to do it again, I’d phase in these clinics,” he says. “[But] with reform, you can stand in front of the train and say ‘Stop’ or you can jump on the train and try to steer it, like we did.”