Do on-site health clinics really work?
A new study links an integrated, employer-sponsored primary care model to a 45% reduction in costs.
SpaceX, a company known for its revolution of space technology, is attempting to modernize another largely untraversed arena — employer-sponsored primary care.
A new peer-reviewed study from Collective Health and One Medical, published in JAMA Network Open, examines the impact of SpaceX’s holistic health care program, which integrates on-site, employer-sponsored health clinics with near-site and virtual primary care. Among the treatment group (those with more than 50% of their primary care visits at on-site or near-site clinics), total health care costs were 45% lower than costs for a comparable population receiving traditional community-based care — the equivalent of $167 per member per month (PMPM). The cost savings were due to lower utilization of downstream care categories such as emergency care, hospital visits and prescription medications.
(Note: several of the study’s authors reported receiving fees from One Medical or its affiliates, or from Collective Health, which sells One Medical memberships to employers.)
Related: 3 considerations for maximizing the value of on-site and near-site health centers
“Combining virtual care with near-site and worksite clinics is proving to be a powerful way for employers to provide convenient access to preventive care, keep employees out of the ER, and lower avoidable costs,” said Raj Behal, MD, MPH, chief quality officer at One Medical. “When you create an effective healthcare home base for employees, you can see significant cost reductions by eliminating the need for more costly downstream care.”
The cost-of-care breakdown
Not all costs declined for members in the treatment group. Spending on primary health care rose by 109% ($20 PMPM) and behavioral health care rose by 20% ($1 PMPM). Additionally, the subsidized services cost employers more on a per utilization basis, with primary care encounters costing a mean of 33% more per episode. Costs were higher for most other encounter types as well; mental health care and imaging were the only areas that saw lower costs per episode.
Yet these spending increases were offset by much lower reliance on more expensive services, including:
- 54% lower spending on specialty care ($11 PMPM)
- 43% lower spending on surgery ($14 PMPM)
- 33% lower spending on emergency department care ($16 PMPM)
- 26% lower spending on prescriptions ($5 PMPM)
Utilization
Across the full population sample, 22.5% used at least one aspect of the employer-sponsored care model, with nearly 10% using this model for most of their primary care. There was little overlap between members who used on-site clinics and those who used near-site clinics: just 2.5%. Overlap with virtual care was higher, with 19% of on-site users and 33.3% of near-site users participating in virtual services. Twenty percent of virtual users never made an in-person visit.
What does this mean for employers?
Employer-sponsored care presents a number of benefits: better availability, convenience and quality of primary care, all of which can prevent utilization of higher cost services. Additionally, study findings suggest that mental health services were used more widely, potentially contributing to a healthier and more productive workforce.
But there are limitations to the findings as well. Though the population samples were controlled for risk score, the study authors allow that members with fewer health concerns may have self-selected into on-site or near-site care, while those with higher health risks opted for a traditional care model. Additionally, the relatively low cross-utilization of services suggests that many members did not take advantage of the integrated delivery systems.
One thing is clear: More research is needed.
“There’s a lack of evidence on the effectiveness of emerging care models like on-site and near-site primary care,” said Dr Sanjay Basu, MD, PHD, director of research and population health at Collective Health. “It is essential to ensure that the evaluations of these solutions are conducted in a manner that leads to rigorous, peer-reviewed research for the community who decides whether such models should be pursued.”
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