Boosted employee health – an unexpected consequence of the COVID-19 pandemic?

It was the end of April 2020. The World Health Organization (WHO) had declared the COVID-19 pandemic just the month before. Some businesses, notably in the food and entertainment industries, grew worrisome that this new infection could have profound effects on their business models. Healthcare organizations working with employers quickly realized it too. In rapid succession, Matrix built a range of workplace solutions that we hoped would control the number of COVID-19 infections, and if not, at least would mitigate their impact on people and operations: These strategies included environmental scans and education, testing and contact tracing and, as soon as this became a realistic option, vaccinations. Testing employees and vaccinating them for COVID-19 required a clinical workforce onsite in places like meatpacking plants and theaters, which we supported through mobile clinics. To ensure the highest use of care, we brought the services to where these people spend most of their day: the workplace. Soon, we recognized that this type of access to care could be extended to any sort of primary care. Indeed, employers, through similar onsite workplace clinics, can offer a broad range of ambulatory care services to employees and their families, and provide better opportunities for workers to improve their overall health and wellbeing.

Our clinical presence in these workplaces has had a number of advantages. First, having a robust clinical offering inclusive of COVID-19 services onsite minimized employee-days-out, allowing operations to run more smoothly. Prior to the implementation of our COVID-19 solutions, multiple sites had to shut down to control outbreaks. After we stood up our services, no other location needed to close for any extended period. Second, the symbiosis of business and external health experts contributed to a higher level of trust of employees in workplace safety. Our internal survey demonstrated a 75% increase in satisfaction with workplace safety after our services were active in a location. Other research shows that almost half of employees who felt they received good support from their employers during the pandemic said they were less likely to leave their company¹. Third, the health of employees became a focus of attention, both for the employer and the employee, promoting business continuity and productivity. Employers clearly realized that it pays off to take care of their workforce. We have seen increased interest of employers who want to acquire worksite health products for COVID-19 support, but also for primary and preventative care.

We suggest that employer sponsored health clinics in the workplace offer chronic disease management (asthma/DM/hypertension), care for workplace injuries, small surgical interventions, management of joint and back pain, vision and hearing assessments, screenings like mammograms and PAP smears with referrals for colonoscopies, pre-natal care and, ―critical in this pandemic era of anxiety― first line behavioral health. This means that employers need to attract both physicians and nurses, through third parties for their expertise in recruiting, training and retaining medical professionals, as well as HIPAA and privacy compliance. Although onsite primary care clinics make sense specifically for employers with many employees per site or for those who are willing to share resources, onsite care models incorporating mobile clinics and telemedicine reduce costs and can be applied to smaller workforces. At worksite clinics, clinicians could bridge gaps in access to primary care for underinsured patients or for those working in high-density workplaces, the so-called ‘industry athletes’ in need of specific attention and care². Alternatively, they could function as a concierge for those who prefer a primary care physician outside of the workplace, as long as the communication between these different care providers is optimal. They could also contribute to high-value care by referring out to a restricted network of specialists providing higher quality for lower costs in value based care contracts.

The link between employers and healthcare is not new. Since World War II, the US has traditionally utilized an often criticized employer-based health insurance system for about half the population³. The risk of losing insurance when changing or losing jobs and unfavorable economies of scale for smaller employers are among some of the issues that also apply to worksite primary care. On the other hand, the absence of a strong primary care system in the U.S. compared to other developed countries (US healthcare spending towards primary care versus OECD average is 5% vs 14%)^{4, 5}and problems with access to care, justifies doing what is possible to bridge the gap. There is ample evidence that better primary care leads to better health outcomes, prevents hospitalizations, lowers disparities and reduces total healthcare costs^{6, 7}. Bolstering primary care by bringing care to the workplace is worth a try.

Employer-linked healthcare clinics already exist. For example, Premise Health reduces inpatient admissions with 41%⁸. Marathon Health employs more than 700 clinicians in onsite primary health centers, saving employers $2K per employee per year⁹. Teledoc provides remote care for employees of companies who cover their services. Amazon Care is doing the same for its employees, and now for others as well. Indeed, ninety-five percent of businesses with more than fifty employees offered at least some telehealth coverage¹⁰, often advertising their services as if they were directly employer endorsed. The model we propose is a combination of Marathon and Teledoc, including remote options for those who work from home. We anticipate that, as we come out of the pandemic, employers continue to realize the importance of employee health for business continuity¹¹, just as policy makers recognize the opportunity for employers to boost primary care through more than tests and vaccines.

Self-insured employers and business healthcare groups, as well as policy makers and regulators should consider this opportunity to booster primary care delivery through employer workplaces, to increase employee health and happiness, and to further enable a productive workforce….It will prove to be valuable, even if only to bridge the time until the U.S.healthcare system realizes that in fact “every individual should be assigned his or her own primary care physician” (advice National Academy of Sciences, Engineering and Medicine, 2021)⁵.

We thank Joe Saundercook, Senior Director at Alvarez&Marsal, for critically reading this manuscript and his helpful comments.

References

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