Back to the Future: The Doctor Is in House

Employee health care is expensive for both employer and worker, and not just in direct costs such as premiums, administration and deductibles.

There’s also the productivity lost when workers take time to travel to, and wait in, the doctor’s office for an exam, and the time lost to illness when a worker puts off dealing with a medical issue.

Would it be cheaper and more effective for all involved if the doctor’s office was an elevator ride away, or a short walk across an office campus, and an appointment was available with little delay?

That’s the question Bellevue-based online travel agency Expedia Inc. and Seattle-based primary-care clinic operator Qliance Medical Management will address with a joint venture into a new model of health care delivery that an increasing number of employers are turning to in an effort to rein in costs and get better results from the dollars they do spend.

Qliance is opening a primary care clinic at Expedia’s downtown-Bellevue location this month. It won’t be exclusively for Expedia employees; it’ll be the sixth clinic in the Qliance chain and open to others enrolled in the plan. But Expedia employees—there are more than 2,000 in Bellevue—won’t have to pay for access to Qliance’s services, which aren’t intended to be a replacement for the health care plans Expedia offers to employees.

So why go to the hassle and expense of adding the service?

Connie Symes, executive vice president of human resources at Expedia, says the clinic is part of “an increased focus on employee well-being” at the company. Dr. Erika Bliss, Qliance’s president and chief executive, says employers have practical reasons for paying attention to employee health. “The health care system is wild and expensive,” she says. “Having an on-site clinic gives them a way to start to try to control costs by encouraging their employees to make better use of primary care and to address things quickly rather than putting them off.”

Employers don’t expect health care’s ills to cure themselves; in fact, they could get worse  when it comes to getting in to see the doctor, once the Affordable Care Act starts pushing more patients into the system.

“They’ve got a very uncontrollable situation,” Bliss says. “On-site clinics are a way to guarantee access to health care for their employees.” They’re also a way to control the quality of the care. When their employees finally get in to see a doctor, she says, “They get seven minutes with them. They get very spotty care that’s very reactive. It’s not really focused on wellness and health promotion. On-site clinics give them an opportunity to address that beyond the typical occupational health approach that used to be the case.”

Thus, the move to employer-sponsored on-site clinics, at a time when many companies would rather be rid of the financial and administrative headaches of being involved in health care, isn’t as counterintuitive as it might first appear.

“What we’re seeing is that companies that ran a clinic themselves or were contemplating running a clinic themselves, they want to get out of that business,” Bliss adds. “But they still like the convenience of having something on site or very nearby because that still solves a lot of their problems. It improves health, improves productivity, reduces time away from work, if it’s a competitive hiring environment, and the tech industry is one of those, it’s a perk of recruiting if you can show you also offer this very convenient high-quality medical care. It’s another arrow in their quiver to attract really great workers.”

The on-site clinic has evolved from the days of the company doctor who, as Bliss says, was mainly focused on workplace-related health issues. Today, vendors like Take Care Health Systems, Healthcare Solutions Centers, Interra Health and Care Here offer employers a way to have on-site health care for employees without having to staff and operate it themselves.

Last year, Microsoft opened its first employee clinic at the company’s headquarters in Redmond. Called the Living Well Health Center, it is operated by Take Care Health Systems, a subsidiary of Walgreens.  Boeing maintains on-site clinics in Auburn, Renton, Everett and Portland, providing occupational-health services including exams, treatment of work-related injuries and physical therapy, as well as urgent care for personal health conditions and health and wellness programs. Google has operated a clinic for employees at its Kirkland site.

The sector is even big enough to warrant its own conference. The Congress on On-Site Employee Health Clinics, scheduled for late January in Phoenix, features on its agenda not only speakers from service providers but also from major employers such as Facebook, Intel and BP.

Qliance (profiled in Seattle Business in September 2009) didn’t start in the employer-sponsored clinic business when it opened for business in 2007, although being a part of employer health care plans has long been part of the model. The company offers access to primary-care services (including X-rays and some basic lab tests) for a flat monthly fee. For employers, it suggests combining Qliance with a wraparound insurance plan to cover the big-ticket stuff like surgery and treatment of disease as a more affordable way to provide health care coverage to workers.

“We’ve been watching the on-site clinic business develop over time and have watched what are the reasons for this, what’s happening out there and what’s being said, trying to understand what are the employers looking for, what are they trying to solve for,” Bliss says.

Qliance executives decided their model would work well in an on-site setting. Expedia is Qliance’s first such venture, but the company is talking to other employers and unions about more. “We definitely have the intention of growing this part of the business,” Bliss says.
Achieving that growth will mean addressing two issues.

For employers, the question is how big do you have to be to make an on-site clinic viable? In the case of Expedia, Qliance is mitigating that concern by having the clinic double as one of its community sites. Setting up a clinic isn’t cheap, Bliss acknowledges, and to set up a clinic exclusively for the use of employees and families of one company would require one much larger even than Expedia.

“They’re capital intensive,” she says. “Generally, with an on-site clinic, the employer is going to pay the setup costs and they’re going to pay in some way for the services provided.” But Qliance’s model is flexible enough that one of its clinics can accommodate a single employer, multiple employee groups in a cluster or community membership. “There are a number of ways you can slice this. The good news for all of them is it’s always another Qliance clinic that’s part of a growing network.”

For employees, the issue is possible discomfort over maintaining privacy while using an on-site clinic. Bliss says that’s the advantage of choosing an outside provider like her company, “which is a recognized brand that is providing health care on site. It helps reassure folks that what they’re getting is an independent primary care provider that happens to reside at their place of work. … We reassure people we’re completely independent from your work. They may or may not pay for your care here, depending on the employer, but it’s a totally private relationship.”

If on-site clinics deliver what backers of the concept promise, the sector could attract more players, including major hospital and health care systems. Swedish Medical Center, which operates a health clinic for its own employees, recently opened a Swedish Physicians primary and urgent care clinic in the South Lake Union neighborhood of Seattle specifically to serve Amazon employees. The clinic is situated in an Amazon building, and Swedish has worked with the company to provide flu and Tdap (tetanus, diphtheria and pertussis) vaccines.

Qliance plans to use the Expedia clinic to test and refine the on-site concept, but it’s also ready to go as soon as another employer indicates a willingness to set up a clinic. Says Bliss, “It really is a fully baked idea, because we already run several primary care clinics.”