Employers embracing new healthcare delivery models

High premium increases and regulations have opened new options for better healthcare delivery

Employers have been reeling from the impact of healthcare marketplace changes and runaway premium hikes. Many have resorted to steadily increasing deductibles, decreasing other benefits such as 401k plans and even downsized their workforces to manage the high costs associated with offering employee healthcare.

Through employer-felt healthcare challenges, new options are gaining traction and more employers are looking beyond the constraints of the typical options to find a better way to deliver healthcare to their employees and their families.

Onsite Clinics

The employer onsite clinic is not a new concept, but it is one that has become more popular as a way to deliver easy access to care while controlling costs.

Liz Thomas, business development manager with miCare Clinic, an onsite clinic model from Third Party Administrator (TPA) EBMS, cites: “Employers who are sick of cutting benefits in the face of continual rising costs are looking for better benefits while controlling their costs. Those that are able to offer superior benefits have the opportunity to become the ‘Employer of Choice’ in their market.”

Onsite clinics like miCare build and staff medical facilities either on or near an employer’s campus for an administrative fee. The costs of offering this model of care are offset by reducing the costs of specialty care and Emergency Room visits that could have been managed at a more primary care level, especially for employers who offer healthcare through a self-funded model.

“With no barriers to care, employers through an onsite clinic are able to capture (and reduce) risk by catching employees early, before diseases spin out of control, delivering improved care and steering utilization appropriately,” Thomas explains.

While onsite clinics are typically built on campus for a single employer, employers in business parks can ban together to share in the expense and benefit for a mutual nearsite clinic.

Direct Primary Care Networks

Another care model that has gained a lot of traction both locally and nationally is Direct Primary Care (DPC). Direct Primary Care is a care model in which most foundational preventive, maintenance and acute care is delivered at a primary care practice without patient copays and typically without out of pocket expense.

“We are able to imbed the EverMed DPC network and model into employer level-funded, self-funded and catastrophic healthcare plans. By injecting the primary care physician as the ‘quarterback’ for employee and family patient care, they are able to prevent a lot of unnecessary specialist and ER visits and even reign in prescription costs. We have seen overall healthcare costs decrease by as much as 30 percent while most employers are seeing average increases of 24 percent,” DPC Core National Sales Director Blake Harp illustrates.

EverMed DPC National Clinic Director Joshua Arguien shares: “The advantage of Direct Primary Care is its accessibility. By removing copays, reducing out-of-pocket costs and eliminating visit fees, Direct Primary Care participants enjoy barrier-free access to the Primary Care environment. As a result, DPC patients catch disease states quicker, leading to lower medical expenses and better health.”

Surgical Care Networks

While only 2.5 percent of health plan participants may require a surgical procedure during the course of a plan year, these procedures can contribute up to 20 percent of the costs incurred for the plan. National surgical network SanoSurgery has a solid presence in Portland and Southwest Washington.

SanoSurgery CEO and founder Dutch Rojas describes: “Steering members of an employer-based health plan to a network of surgery centers and specialists that offer services at a discounted, transparent, fixed costs can lead to substantial savings (30-50 percent per procedure).”

Like Direct Primary Care, Surgical Care Networks can be imbedded into employer health plans, incenting utilization with reduced or no copays for employees and their families. In addition to surgical procedures, the SanoSurgery network add access to similar cost savings for physical therapy, pain management, chiropractic care and imaging.

Discounted Urgent Care

While oft maligned as a cost driver in the healthcare marketplace, a new trend is developing within the Urgent Care arena. An employer-based discount model called CoreCare offers Urgent Care center-wide discounts for employees, including waived facility fees. These services may include annual flu shots at no cost to the employee and access to growing national network of connected urgent care clinics.

Dan Reese, director of sales and marketing for AFC Urgent Care of Portland shares: “These types of plans offer employees easy and convenient access to quality care. Typical insurance coverage may include high deductibles, expensive copays and carry the stigma of complication. These can create a barrier to access in the minds of employees. Unfortunately, employees still get sick and injured. With these membership plans, employees can have predictable and reliable access to care seven days a week at no (or minimal) cost.”

Mix and Match

These entrepreneurial approaches to providing employers options in delivering care conscious, cost conscious care to their employees tend to welcome a mix and match approach.

“We can work with an employer that really likes the idea of an onsite clinic, for example, but wants to reach family members that don’t want to be treated at their spouse’s place of work. We can bring in an onsite clinic and add the direct primary care or an urgent care model to deliver greater geographic coverage into the communities where the employees live,” Harp adds.

Seth Sjostrom is the Chief Strategy Officer for Camas-based healthcare company EverMed DPC. He is a novelist with published titles “Blood in the Snow” and “Finding Christmas,” as well as a frequent contributor to healthcare trade journals and the Vancouver Business Journal.