September 07, 2019
During a recent session at PCMH Congress 2019, held in Boston, MA, Kathryn E Gibson, MD, FAAFP, medical director of Health and Wellness at ARUP Laboratories, identified rationale for the alignment of workplace health needs and PCMH principles, described the implementation of a PCMH framework at an employer-based worksite clinic, and provided examples as to how PCMH principles within a worksite clinic lower costs and improve health outcomes based on experiences within her own company.
Dr Gibson explained to the audience that 1 in 2 Americans have employer-sponsored health benefits, and she said that health care is the second largest employer expense totaling roughly $880 billion, according to the Integrated Benefits Institute. Additionally, she said that 81% of large firm workers are enrolled in completely or partially self-funded plans.
Importantly, she noted, that costs of productivity loss due to poor health total 2-3 times the cost of health care. Further, presenteeism totals three-quarters of cost, and absenteeism totals one-quarter of cost.
According to the Worksite Medical Clinics 2018 Survey Report, 67% of employer-sponsored clinics allow their members to choose clinics as their primary care provider, and 35% of employers say their clinics serve as a PCMH.
“As more employers provide primary care, there is an incentive and an obligation to provide patient-centered, value-based, comprehensive and coordinated care as a PCMH within the health care neighborhood,” said Dr Gibson.
Dr Gibson discussed the implementation of an occupational health clinic to PCMH at ARUP Laboratories [ARUP]. She said that ARUP was founded in 1984 and has 4000 employees. Dr Gibson explained that in 1992 an employee clinic was established under CEO Dr Carl Kjeldsberg. She said concepts of the clinic included leadership support, which had a commitment to community health and well-being, and the culture was convenient and expected to engage in health behaviors. She noted that health behaviors and job safety were linked to job performance.
She then jumped ahead to year 1999 where she discussed an expanded scope as well as extended hours. She said the scope included 40-60% of new employees did not have a primary care provider, and they welcomed patients with an existing primary care relationship. Next in 2000, there was increased space, and in 2004 there was on-site daycare and fitness facilities.
In 2008, primary care was introduced, and in 2009 there was a value-based insurance design. According to Dr Gibson, “low cost drives initial uptake in utilization, but then positive experiences and relationships drive care.”
Next on Dr Gibson’s timeline was 2010 where there was a commitment to PCMH. During this year there was increased privacy and trust, and the company collected and leveraged data for health risk assessment and claims data. From 2011 through 2013, new foundations were introduced. These included staff structure and communication—not only among staff, but also communication within the community and among patients.
In 2014, the IT infrastructure was changed, and there was a significant financial investment with significant reward. Further, there was increased data integration over systems and platforms, including medical, pharmacy, dental, vision, leave and disability, payroll, and performance. Next in 2015, the company focused on care as a whole. Within the care team there were new roles, new processes, training, and communication. They measured performance in 2016, which lead to setting goals and initiating a change. They also focused on quality improvement during this year.
During 2017, they began to expand access. The concept of 2017 included the management structure—employer-managed versus vendor versus blended—as well as performance accountability. In 2018 through 2019, they continued to expand access. They focused on accessibility, scaling, and revisited cost.
Overall, ARUP experienced a successful transformation from an occupational medicine-focused work-site clinic into a medical home that cares for more than 10,000 patients.