The Ongoing Expansion of Worksite Health

Affordable Care Act uncertainties be damned—employers are going ahead with their plans to launch on-site health centers.

That seems to be the overarching message to emerge from Mercer’s new targeted survey on worksite clinics.

The New York-based consultancy’s poll is actually a follow-up of sorts to last year’s National Survey of Employer-Sponsored Health Plans, in which 29 percent of organizations with 5,000-plus employees that provide an on-site or near-site clinical site said they offer primary care services. (That figure marks a 5 percent increase in the number of companies saying the same in 2013.)

For this recent survey, all participants from the 2014 poll that reported offering a worksite clinic were invited to answer detailed follow-up questions about their clinic operations. Among the 134 respondents, 91 percent of those with clinics identified controlling total health spend as a “very important” or “important” objective in establishing an on-site center. For 77 percent of survey participants, reducing lost employee productivity was also a key goal, with 68 percent saying they consider improving member access to healthcare important or very important.

These findings are very much in line with what Towers Watson’s 2015 Employer-Sponsored Health Care Centers Survey uncovered earlier this year. In that survey, 75 percent of 105 organizations currently offering employer-sponsored health centers cited increasing productivity as a key goal, with 74 percent indicating the same about reducing healthcare costs, and 66 percent reporting they hope to improve employee access to healthcare services.

What experts at both Towers Watson and Mercer find most interesting about these figures, however, is the suggestion that the ACA’s infamous excise tax hasn’t deterred many employers from building new on-site health clinics, or from expanding existing centers.

“ … Companies are adding centers despite concerns around the Affordable Care Act and its excise tax, which [requires] that the cost of an on-site center has to be included in the cost of delivering healthcare to employees,” Allan Khoury, senior health management consultant at Towers Watson, told HRE in June.

“If that cost goes too high, you violate the Cadillac tax. But we’re still seeing great support for these clinics among employers.”

That’s not to say companies aren’t concerned that on-site health centers’ operational costs could help push them over the threshold for the excise tax, of course. But, by and large, most organizations remain convinced that their clinics “will deliver positive net value,” said David Keyt, principal and National Onsite Clinic Center of Excellence leader at Mercer, in a statement.

In the latest Mercer survey, 15 percent of respondents said they believe their general medical clinic will hurt them in terms of the excise tax calculation, but 11 percent said they think it will help, “presumably by helping to hold down the cost of the company’s health plan,” according to Mercer. Twenty-eight percent think it won’t have an effect either way.

And, ultimately, most companies aren’t really using cost as a barometer for the value of their on-site health centers anyway, according to Keyt.

“For many employers, employee satisfaction is a more important measure of success than ROI,” he said. “If employees are using the clinic, it means they haven’t been taking time off work to visit a doctor, and that they’re getting the medical care they need to stay healthy and productive.”