Worksite Model

Worksite models have been used to integrate health and human services in some rural communities, given that many people are unable to take time off from work to seek needed services. Further, people living in rural communities may live or work in a location where they do not have access to health and human services.

Rural communities are integrating services at worksites in different ways. Outreach workers, such as community health workers, may travel to the worksite to deliver services. This approach is used to increase access to health and human services for migrant health workers who may not be able to take time off from work to seek needed services. Other barriers to care for migrant health workers and their families include:

• High costs of healthcare
• Lack of culturally or linguistically appropriate services
• Lack of sick leave
• Lack of information and awareness about healthcare insurance options and services

The Care Coordination Model describes examples of outreach programs that are connecting migrant health workers to important resources.

Another way to integrate services at the worksite is through a workplace clinic. Onsite workplace clinics are increasing in popularity because they benefit both the employer and the employees. Employer motivations for opening a workplace clinic include long-term reduction in direct medical costs, improvement in population health with focus on health promotion and wellness, and opportunities for improvement in access to and quality of care. Almost all workplace clinics include occupational health services. Additional services include acute care, preventive care, wellness, and disease management. Wellness programs have grown in popularity due in large part to certain employer provisions and healthcare reform incentives.

There are three main models of clinic management that employers can consider for onsite workplace clinics:

• Hiring a third-party vendor to operate a clinic
• Contracting with external healthcare providers to staff a clinic
• Directly employing all clinic staff and management

Contracting with healthcare providers in the community is a potential option for small rural communities with limited managed care networks.

Examples of Rural Worksite Programs

• Quad/Med, a subsidiary of a large commercial printing company called Quad/Graphics, designed a model of healthcare delivery that integrated worksite primary care services with wellness programs and a direct contract with a specialty and hospital provider network. This is an example of an in-house, full-service worksite model. Their onsite worksite clinics offer primary care, dental and vision care, occupational medicine and select specialty services. The clinic is staffed with a medical director, two full‐time physician assistants, a nurse manager, and nursing staff. In addition, QuadMed patients have access to off-site services including a pharmacy, laboratory, rehabilitation clinics, fitness centers, and mental and behavioral services through an employee assistance program. Quad/Med clinics are located at or near three Quad/Graphics plants in Wisconsin, New York, and West Virginia as well as at three other companies in Wisconsin and Missouri including MillerCoors Brewing, Briggs & Stratton, and Northwestern Mutual. Most of these plants are located in urban areas, however Quad/Med also has a presence in rural areas such as Lomira, WI. The organization found that emergency room usage has been reduced over 50%. This model requires a large upfront investment and may not be feasible for most employers.

Considerations for Implementation

The decision to implement a worksite model depends on the employer's needs, resources, and capacity. Types of employers that are implementing workplace clinics include large self-insured employers and small employers looking to sponsor part-time clinics or operate a “near-site” clinic through a partnership. Some surveys have found that rates in developing onsite programs are highest among firms with employee populations greater than 1,000 people. Start-up challenges for workplace clinics are vast and initial investments could range from several thousand to millions of dollars. Considerations from employers include the scale and scope of services. A key component of worksite health programs is a distinct separation between the healthcare vendor and the employer to ensure patient confidentiality. One survey found that measuring the impact of workplace clinics can be challenging.

Resources to Learn More

QuadMed: Transforming Employer-Sponsored Health Care through Workplace Primary Care and Wellness Programs
Document
This case study describes the development and characteristics of the workplace clinic model used by QuadMed.
Author(s): McCarthy, D. & Klein, S.
Organization(s): The Commonwealth Fund and Issues Research, Inc.
Date: 7/2010

Rural Migrant Health
Website
This topic guide is designed to serve both as an introduction to Migrant Health and as a reference that collects a variety of resources including documents, organizations, tools, funding opportunities, news items, events, and program examples.
Organization(s): Rural Health Information Hub

Workplace Clinics: A Sign of Growing Employer Interest in Wellness
Document
This research brief examines the potential for workplace clinics to improve health and contain costs. It addresses current models of workplace clinic management, key challenges of planning and implementation, and policy implications.
Author(s): Tu, H., Boukus, E., & Cohen, G.
Organization(s): Center for Studying Health System Change
Date: 12/2010