The survey of 365 of the nation’s leading companies found:

• 62% of companies said they implemented wellness programs to improve employee health
• 33% said they were considering such programs
• 64% said rising health care costs were "a major factor in our decision" and
• 34% said high costs played some role
• 5% of the companies surveyed said they don’t have wellness programs or plans for them
• 2% of those with wellness programs said rising health care costs played no role in adopting them

The survey found the companies are offering a variety of wellness programs to promote employee health, including:

• 61% - Health risk assessments
• 56% - Smoking cessation programs
• 50% - On-site workout facilities
• 48% - Adding healthier foods to menu in company cafeterias
• 48% - Employee diet groups
• 43% - Subsidized gym programs
• 32% - Prevention: including free flu shots, healthier vending machine choices, wellness Web sites, and on-site massage therapy
• 27% - Allow employees to use time during the work day to exercise
• 27% - Diet counseling

47% of respondents said they are offering employees incentives to participate in wellness programs, including:

• 48% - Gift certificates, prizes, and free membership to on-site exercise facilities
• 29% - Cash payments
• 30% - Rebate of program costs
• 15% - Reduced medical co-pay costs

Of those companies that offer wellness programs, most report that less than a quarter of employees are participating:

• 32% - Less than 10% participate
• 29% - 11 to 25% participate
• 23% - 25 to 50% participate
• 11% - 50 to 75% participate
• 4% - 76 to 90% participate
• 1% - More than 90% participate

Source: Deloitte Center for Health Solutions and the ERISA Industry Committee (ERIC), 6/22/05

The results of 44 studies investigating financial impact and return on investment (ROI) from disease management (DM) programs for asthma, congestive heart failure (CHF), diabetes, depression, and multiple illnesses were examined. A positive ROI was found for programs directed at CHF and multiple disease conditions. Some evidence suggests that diabetes programs may save more than they cost, but additional studies are needed. Results are mixed for asthma management programs. Depression management programs cost more than they save in medical expenses, but may save money when considering productivity outcomes.

Study findings

• Four of the five studies that used the optimal research design produced a positive ROI.
• The cost of DM programs for congestive heart failure averaged $1,399 per participant, and savings averaged $3,884. The average ROI, achieved in a little less than a year, was $2.78 in savings per dollar spent on the program.
• Many of the studies that looked at DM programs for asthma showed savings, but only two of the better-designed studies delivered enough savings to produce a positive ROI (and these studies covered very few cases.)
• The results for diabetes were too variable to provide conclusions.
• Among programs managing patients with multiple diseases, the ROI ranged from $4.37 to $10.87 in savings per dollar spent on these programs, over an average of 1.4 years.
• DM programs targeting depression consistently cost more – about $500 more a year – than they saved in direct medical costs. "On the other hand," Goetzel says, "these programs may deliver a positive ROI if we factor in the impact on patients' day-to-day functioning, absenteeism, and overall productivity."

Source: Cornell University and Thomson Medstat, Summer 2005

Study concludes that early intervention led to a 4:1 ROI for low-risk patients and a 6:1 ROI for high-risk patients.

Source: RAND. Evidence Report and Evidence-Based Recommendations: Health Risk Appraisals and Medicare. September 29, 2003. Baltimore: U.S. Department of Health and Human Services, 2003

Diabetes screenings yield positive returns as high as $36.00:1.00.

Source: MEDTAP International. The Value of Investment in Health Care. Bethesda, Maryland: MEDTAP, 2001

An early intervention and wellness program in Alabama resulted in a $19.40:1.00 benefit to cost calculation.

Source: The Health Project. "The Health Project: Employees of the City of Birmingham, Alabama." The Health Project

Johnson and Johnson conclude that health and productivity programs may produce a $10.00:1.00 ROI.

Source: Johnson, Richard E. and Peter G. Johnson, M.D. "Are H&P Programs For You?" Strategic Finance. Montvale, NJ: Institute of Management Accountants, December 2003

Study found that early intervention reduced sick leave 22.2%, per capita Worker Compensation cost was 83.4% lower, and the ROI was $4.24:1.

Source: The Health Project. "The Health Project: Providence General Hospital, Everett, Washington." The Health Project

Study of the cost-effectiveness of the use of web, phone, and mail interventions finds that participants save $41 per member per month and result in a $2.90:1.00 ROI.

Source: Gold, William R., M.D. and Pater Kongstvedt, M.D. "How Broadening DM's Focus Helped Shrink One Plan's Costs." Managed Care Magazine. November 2003. Yardley, PA: MediMedia, 2003

Study of diabetics found that there were savings between $685 and $950 per patient per year among those in patient self-management programs.

Source: Congressional Budget Office. An Analysis of the Literature on Disease Management Programs. October 13, 2004. Committee on the Budget, United States Senate. Washington, D.C.: Congressional Budget Office, 2004

ROCHESTER, NY – The latest Wall Street Journal Online/Harris Interactive Health-Care survey of 2,624 U.S. adults, ages 18 and old, reveals that the medical profession is lagging behind other service sectors and professions in its use of Internet-based solutions to communicate with and manage customer information—in this case, patients and their medical information.

Patients would like to see medicine move in this direction, and most adults say that they would like to have access to electronic medical records and other electronic means of communicating and transferring medical information. If given a choice between a doctor who provides such services and one who does not, more than half of all adults believe this would influence their choice of doctors. In the future, physician practices that choose to invest in and use health information technology could find themselves at an advantage.

Survey Findings	Nationwide	CareHere
		CareHere provided the data in this column and was not provided by Harris Interactive.
75% of adults say they would like to have the ability to schedule a doctor’s visit via the Internet	3% currently use and 4% have it available to them, but do not use.	100% of patients can schedule their appointment online
74% of adults would like to use email to communicate directly with their doctor	4% currently use and 4% have it available to them, but do not use.	100% of patients can email providers, and visa versa.
67% of adults would like to receive the results of diagnostic tests via email	2% currently use and 3% have it available to them, but do not use.	100% of CareHere patients are alerted that lab results may be viewed online.
64% of adults would like to have access to an electronic medical record to capture medical information	2% currently use, and 3% have it available to them, but do not use.	100% of CareHere patients can view their medical record (except doctor notes).
57% of adults say they would like to use a home monitoring device that allows them to send medical information – like blood pressure readings or blood tests – to the doctor’s office via the telephone or email	2% currently use, and 3% have it available to them, but do not use	CareHere has introduced Bluetooth-enabled patient reporting devices for home and mobile monitoring.

Electronic Medical Records

When it comes to the value of using electronic medical records, most adults who are online agree strongly or somewhat that it would improve the quality and safety of medical care and reduce cost of healthcare. However, most also believe that electronic medical records may present a challenge to ensuring patients’ privacy:

• 68% of adults feel the use of electronic medical records can improve the quality of care patients receive by reducing the number of redundant or unnecessary tests and procedures they receive.
• 62% feel it more difficult to ensure patients' privacy.
• 60% feel can significantly reduce healthcare costs.
• 55% feel can significantly decrease the frequency of medical errors.
• 54% prefer a doctor who provides an electronic medical record over one who does not.

Note by CareHere: 100% of physicians and medical staff use an electronic medical record to chart CareHere patients.

About The Wall Street Journal Online

The Wall Street Journal Online by Dow Jones & Company (www.dowjones.com), is the largest paid subscription news site on the Web. Launched in 1996, the Online Journal continues to attract quality subscribers that are at the top of their industries, with 766,000 subscribers world-wide as of Q2, 2006.  Visit www.wsj.com.

About Harris Interactive

Harris Interactive is the 12th largest and fastest-growing market research firm in the world. The company provides research-driven insights and strategic advice to help its clients make more confident decisions which lead to measurable and enduring improvements in performance. Harris Interactive is widely known for The Harris Poll, one of the longest running, independent opinion polls and for pioneering online market research methods. Visit www.harrisinteractive.com.

Source: Wall Street Journal Online/Harris Interactive Health, 9/22/06, www.harrisinteractive.com

The IRS permits Employee Achievement Awards which are excludable from the employee's gross income. That is, the employer does not withhold federal income, social security, or Medicare taxes on the fair market value of an employee achievement award. Excludable employee achievement awards also are not subject to FUTA tax.

A health and wellness incentive is a form of Employee Achievement Award according to Sumner County (Tennessee) Law Director's Office. They conclude, "We can offer health incentives up to $400 for participation in our Health Risk Assessment (HRA) program based on the IRS Employee Achievement Award language." Based on their analysis, the County is offering its employees Wal-Mart Gift Cards valued at $100 as an incentive to participate in the HRA.

Tax Free Health & Wellness Incentive Criteria

To be excludable from your employee's gross income, the award must meet the following criteria:

• Be tangible personal property (not cash, gift certificates, or securities) given to an employee for length of service or safety achievement, awarded as part of a meaningful presentation, and
• Awarded under circumstances that do not indicate that the payment is disguised compensation.
• The most that you can exclude for the cost of all employee achievement awards to the same employee for the year is $400.
  • A higher limit of $1,600 applies to qualified plan awards.
  • Qualified plan awards are employee achievement awards under a written plan that does not discriminate in favor of highly compensated employees.
  • An award cannot be treated as a qualified plan award if the average cost per recipient of all awards under all of your qualified plans is more than $400.
  • There are two types of employee achievement award plans, tax qualified and non tax qualified. A tax qualified employee achievement award plan is an established written plan that does not discriminate or favor highly compensated employees. A tax qualified employee achievement award plan can deduct up to $1,600 for all employee achievement awards to the same employee on it's tax return during a taxable year. The average cost of all employee achievement awards during the tax year for all employees cannot exceed $400.

Source: Internal Revenue Service, www.irs.gov/publications/p15a/ar02.html#d0e1040

IRS Advice to Employees Receiving Achievement Awards

If you (individual tax payer/employee) receive tangible personal property (other than cash, a gift certificate, or an equivalent item) as an award for length-of-service or safety achievement, you generally can exclude its value from your income. However, the amount you can exclude is limited to your employer’s cost and cannot be more than $1,600 ($400 for awards that are not qualified plan awards) for all such awards you receive during the year. Your employer can tell you whether your award is a qualified plan award.

Your employer must make the award as part of a meaningful presentation, under conditions and circumstances that do not create a significant likelihood of it being disguised pay.

Source: www.irs.gov/pub/irs-pdf/p525.pdf, Page 3

Onsite medical clinics are helping employers manage health care costs, reducing time spent on doctors’ visits and recovery, and spurring employees to adopt healthier lifestyles that help both them and the company in the long term.

"I think it's a modern model that is indeed proving to be cost-effective," says Sean Sullivan, president, CEO and co-founder of the Institute for Health and Productivity Management, a nonprofit corporation in Scottsdale, Ariz., that works to link employee health to corporate performance. "Not only does it pick up health issues earlier, but it doesn't require time away from work and at the same time creates a culture of caring."

Financial Returns

Although there is little collective data quantifying the cost-effectiveness of corporate clinics, employers who have invested in them say the payoffs are tangible and significant.

By making on-site health services available—especially for treating minor illnesses and injuries and providing follow-up care—employers can reduce the number of visits employees make to more costly facilities, such as physicians’ offices and hospital emergency rooms. In addition, on-site facilities can help employees manage chronic health conditions and maintain better overall health, while reducing the amount of time they spend away from the job visiting off-site providers.

Onsite Clinics Growing

There's evidence that organizations are turning to on-site clinics as a major strategy in their overall health benefits programs.

• According to a study by Watson Wyatt Worldwide, an HR consulting firm based in Washington, D.C., 33% of 275 organizations that collectively employ more than 4.9 million workers have implemented on-site medical clinics or plan to add them this year.
• The Pepsi Bottling Group is one company that has demonstrated a growing interest in on-site facilities. It operates 11 employee health clinics at facilities in the United States and plans to add 15 more across North America in the next few years.

Pepsi tracks results on their 11 on-site health care facilities. For instance, during 2004 and the first half of 2005, employees made 865 visits and follow-up visits to the company's Baltimore wellness clinic for both occupational and non-occupational reasons. "We saved nearly $100,000 by having them visit our clinic instead of a doctor's office," says David Kasiarz, vice president for compensation, benefits and risk management. "We also saved more than $50,000 during that same time period in replacement labor expenses for those visits—and time employees took for other procedures, physical therapy appointments, DOT certification and drug testing at our clinic."

On-Site Clinic Deliverables

• Delivering care with greater access and lower costs.
• Addressing employees’ overall health issues.
• Introducing programs that counsel individual employees on their risk factors for disease.
• Working closely with high-risk employees.
• Introducing the doctor to people who do not normally see a doctor.
• Providing risk management on workplace safety.
• Providing on-the-job treatment of injuries and illnesses.
• Compliance with federal Occupational Safety and Health Administration regulations.

Onsite Clinics Work Best With Self-Funded Employers

David Beech, a health care consultant in the Los Angeles office of Washington, D.C.-based Watson Wyatt Worldwide, an HR consulting firm, works with employers to evaluate the feasibility of on-site clinics. He says most companies that pursue this option are self-insured and have at least 700 employees—an informal threshold of size for supporting a basic clinic.

A comprehensive, full-scale clinic—one that offers acute care, preventive exams and additional specialization, such as physical therapy or basic radiology—would require at least 2,500 to 3,000 employees to justify a front-end investment of roughly $3 million to $4 million, Beech estimates.

However, many self-funded employers with 100 to 900 employees have successfully introduced onsite medical clinics. "Our clients that have fewer than 1,000 employees are enjoying the same kind of savings that our larger employers (2,000 employees and more) have experienced from onsite clinics," said Ben Baker, Chief Operating Officer, CareHere, a onsite medical management firm based in Brentwood, TN. "The majority of our clients cut their healthcare cost trend in half after the first year," Baker added.

Outsource or In-House Management of Onsite Clinics

When an on-site health facility is outsourced, the vendor pays the clinic staff, handles liability and malpractice insurance, and ensures privacy of health information. This method eases administration and reduces risk. It also can give a company a more customized approach for meeting the needs of its particular workforce.

Lowes Saves $16 Million

It was reported in Benefits News on 4/4/06, that Lowe's has improved its bottom line without weakening benefit levels for workers. The company saved $16 million on health benefits by combining several strategies including: having no co-pay for generic medicines, installing four onsite health clinics, giving workers an incentive to complete a health risk assessment, and more. As a result, Lowes has held premium increases to 5% or 6% for the last three years, which was lower than the 8% to 9% national average for employers.

Bob Ihrie, vice president of compensation and benefits, says, "We've had great reception with the clinics so far. The feedback we get from employees is, don't complicate benefits too much."

The Mooresville, N.C.-based home improvement retailer spends about $600 million per year on health insurance and covers 195,000 lives. Lowe's pays for 68% of the premium, which is close to the national average for employers. The company hasn't changed its contribution level, deductibles or out-of-pocket maximums for five years, something that Ihrie points out with pride.

Sources: SHRM article: Getting Personal (HR Magazine),  4/2006, www.shrm.org, and Benefits News, 4/4/06, www.benefitnews.com

An on-site medical center mimics a primary care (e.g., family practice) physician's office with one or more treatment rooms and basic diagnostic and laboratory equipment. It may be staffed with physicians and/or nurse practitioners and technicians. Centers serving a more limited patient population may rely upon a nurse practitioner as the first stage clinician. Patient demand and hours of operation dictate actual staffing levels.

Many on-site centers offer occupational health services in addition to basic primary care. The typical on-site medical center offers:

• Routine medical care
• Immunizations
• Basic radiology and laboratory testing
• Physical examinations
• Preventive screenings
• Health education, consultation, and wellness (nutrition counseling, cholesterol screening, prenatal
  programs)
• Basic adolescent and child care, including back-to-school and sports physicals
• Chronic disease management
• Case management

On-site pharmacies have also gained popularity among employers having a critical mass of employees in one location. Some employers seek maximum leverage and offer both an on-site pharmacy and medical center. Others will feel more comfortable beginning with an on-site pharmacy, monitoring experience, and then adding the medical center once the economic argument presents.

Who Is Offering On-Site Clinics and How?

Medical on-site centers are not new. Many employers offering on-site treatment began with occupational health services and expanded services to encompass primary care medicine. It is becoming less common for employers to directly employ clinical staff due to concerns about exposure to medical liability and employee privacy. More commonly, employers contract with a management firm that recruits and hires clinical staff, and provides the center with diagnostic equipment and the information systems needed to operate in today’s electronic world.

These firms are then paid a management fee subject to a multi-year agreement. Generally, private and public employers need a minimum of 2,000 employees in a single location in order to create the business case for an on-site medical center and/or pharmacy.

While the precise number of employers with on-site primary care centers is not available, we estimate between 200 and 300 employers have adopted this offering. Originally confined primarily to rural area locations to address medical provider access problems, on-site centers and pharmacies are gradually appearing in suburban and even urban offices of many high-profile employers.

Why are an increasing number of employers attracted to on-site clinical services?

While employer disappointment with past cost management is important, many employers see opportunities to save money with a more holistic approach to worker health. These employers are prepared to consider solutions that previously seemed too risky or radical. As employers learn more about the comprehensive services and the value on-site center/pharmacy vendors can bring, the solution appears less radical.

Not a Panacea

Worksite centers and pharmacies will not work for all employers having 2,000 or more employees in a single location. Employers considering such services need to answer the following major questions:

• Will the on-site center and/or pharmacy deliver savings? Employers must conduct an independent feasibility analysis to ensure they will receive return on investment.
• Is there adequate physical space available for a center and/or pharmacy?
• Does the program financing make sense? Since most leading vendors in the on-site industry operate under a "cost plus" arrangement, employers must have the financial capital needed for staffing, equipment (e.g., radiology and laboratory testing), and medical and drug supplies.
• Will the local culture accommodate the on-site center/pharmacy? Will employees make use of the resources?
• Is senior management prepared to provide visible support and encourage utilization, even as they respond to negative feedback from local primary care physicians or pharmacies threatened by the service(s)?
• Does the prospect of a multi-year commitment to supporting on-site medical services make senior management nervous?
• Can the risk management and employee benefits staff break down historical silos to achieve the synergies possible from better integration of group medical and occupational health offerings?
• Will the sponsored health plan communicate effectively with the on-site clinical staff to improve care management of high-cost claimants?
• Will the health plan accommodate the reduction or elimination of out-of-pocket costs for services received at the on-site center?

Summary

On-site medical centers and pharmacies can deliver net value to many employers having a sufficient number of employees in a single location to warrant the capital investment. Many larger employers are exploring the feasibility of these centers. A prudent, calculated process must be employed to initially affirm feasibility, followed by a thorough competitive bidding process to weigh alternatives and select the best business partner for the employer.

Advantages of On-Site Medical Services

Some of the advantages offered by on-site medical services include:

• Enhancing the efforts of health promotion and disease management programs by using on-site clinical staff to provide health coaching to individuals with chronic illness or poor health habits, as well as to guide employer-sponsored wellness programs.
• Improving treatment outcomes by referring to higher quality, more efficient specialists and hospitals.
• Eliminating the cost of unnecessary medical services (e.g., expensive diagnostic imaging and emergency room visits).
• Minimizing medical practice variation—and enhancing compliance with evidence-based medicine—by having a primary care physician oversee the full spectrum of care delivery.
• Integrating occupational health (including workers’ compensation) and group health strategies.
• Shortening disability and workers’ compensation absences by working with supervisors to create modified duty accommodations.
• Increasing worker productivity (less time off from work to drive to medical appointments).
• Providing more convenient access to preventive care services, leading to earlier detection and improved health outcomes.
• Improving the primary care experience by giving on-site physicians and nurses more time with each patient to explore psycho-social aspects impacting health status.
• Increasing employee commitment and morale, if delivered effectively.
  
  Pharmacy Services
   
• Maximizing discounts from directly purchased drugs, using the so-called “closed door” class of trade, that exceed those available from pharmacy benefit managers (PBMs).
• Maximizing generic drug substitution, the single most important step in controlling prescription drug costs.
• Improving drug use compliance by relying upon on-site pharmacist counseling.
• Promoting use of formulary drugs.
• Utilizing pharmacists to counsel the chronically ill, especially concerning medication adherence.

About Aon

Aon Corporation is a leading provider of risk management services, insurance and reinsurance brokerage, human capital and management consulting, and specialty insurance underwriting. There are 47,000 employees working in Aon’s 500 offices in more than 120 countries. Backed by broad resources, industry knowledge and technical expertise, Aon professionals help a wide range of clients develop effective risk management and workforce productivity solutions. Visit www.aon.com.

Source: Aon Consulting FORUM, 3/2006, www.aon.com/about/publications/pdf/issues/march_06_article3.pdf

Onsite or worksite medical clinics are successfully being deployed in various locations throughout the county. Articles have been published reporting favorable results from self-funded employers having recently installed onsite clinics and from those with long-term (over 10 years) results.

Recently, we have been asked if onsite dental should be considered. With the success of onsite medical clinics, I would be the first to support exploring the idea of onsite dental clinics.

However, justifying onsite dental clinics economically is a challenge with the following considerations:

• Economics of medical personnel mix more favorable to medical than dental
  • Medical doctors or physician extenders (nurse practitioners or physician assistants) can easily see 3 to 4 patients per hour with only 2 persons: Physician and medical assistant.
  • However, dentists must have one hygienist for each patient with each appointment generally taking an hour. Seeing 3 dental patients per hour would require 4 persons: Dentist and 3 hygienists.
• Doctor office visits typically cost more than dentist visits
  • Break-even analysis is more demanding for justifying onsite dental services with fewer dollars.
• Medical clinics are less expensive to equip than dental clinics
  • Equipping a medical clinic can cost $6,000 (equipment, supplies and initial medications).
  • A single dental chair can exceed $15,000.
• Marketing opportunity for onsite dental is limited.
  • Most employers provide health coverage.
  • Fewer employers provider dental coverage.
• Employers are very conscious of medical costs and their annual increases...and do not follow dental costs as closely.
  • Annual composite medical cost per employee can exceed $7,000.
  • Annual composite dental costs per employee can cost 10% of medical costs.

Medical and dental use and economics can easily vary by self-funded plan. Considering onsite dental is commendable, making it work is tougher.

Source: CareHere appearing in MyHealthGuide Newsletter, 9/25/05, www.myhealthguide.com

Bringing the doctor to the workplace can be specially helpful for workers who delay seeking preventive health care for various reasons, including cost, lack of transportation or too much time spent in doctors' waiting rooms.

Among the growing number of companies restoring the role of the company doctor is American Retirement Corp (www.arclp.com), a self-funded employer based in Brentwood, TN. The company has 3,500 covered employees and operates 67 retirement communities in 14 states.

In 2002, when the company's health claims came in a whopping $4 million over budget, American Retirement decided to make it easier for its employees to access care. The company opened on-site clinics at the two facilities that were most over budget--one in Tampa, FL and another in Peoria, AZ. "We had been considering bringing physicians on-site, and when our budget exploded, we took action," says Laurie Mathis, senior director of benefits.

American Retirement Contracts with CareHere

American Retirement contracted with CareHere, a Brentwood, TN company (www.carehere.com) that offers on-site medical care, to place board-certified family practice physicians in both facilities. CareHere physicians work with employees to complete health risk assessments, conduct lab tests to identify risk factors and diseases, then coach employees and manage their care. As an outside consultant, CareHere can monitor the health of individual employees while maintaining confidentiality as required by federal and state laws.

Each facility now has physician on-site for four hours a day for two to three days a week. The doctors serving American Retirement provide primary care and monitor employees' health conditions. Employees can schedule appointments online, via a toll-free number or directly through the clinic. "The doctors generally see 12 or 13 patients in a four-hour period," says Mathis. The physicians hourly fees, paid by American Retirement through CareHere, are $90 and $100, and the physicians, provide their own malpractice insurance.

To encourage employees to use the voluntary program, complete their health risk assessment and undergo lab tests, American Retirement offers gift certificates for nearby retailers. "Response has been great," says Mathis. "We're finding people in the early stages of diabetes, hypertension and other diseases and conditions."

Medications Dispensed On-site

Like many of CareHere's clients, American Retirement provides selected generic medications through the on-site physicians. "About 20 such medications are dispensed without charge because they save us money and we are analyzing whether it would be cost effective to add an additional 29 drugs to the list," Mathis says.

On-site Clinic Contributes to $400,000 in Savings

"The cost of setting up and maintaining the on-site clinic last year -- which included the physicians, other health specialists as well as supplies -- came in $8,000 under the $100,000 budget," says Mathis. The company's goal was to break even the first year and reap savings over time, but actual results are better than expected, Mathis says. "In Tampa before the onsite clinic was started, we were running $450,000 over budget [in total health care expenses] from January to June 2003. After the clinic was started, from July to December, we reduced that overage to $50,000. Not all the $400,000 savings came from the on-site clinic, but it definitely made a difference."

Another plus to the system is that the in-house physicians assign diagnostic codes to each patient visit (employee or dependent), allowing CareHere to paint an electronic picture of usage in the clinics and to compare expenses with the cost of comparable care in an outside facility. This also creates a database the company can use in predictive modeling and in structuring its benefits program.

"Employee surveys show that 95% of the employees are very pleased with having the doctor on-site," Mathis says, "We think this has been good for employee morale and feel sure it will result in considering cost savings downstream."

Source: HR Magazine, June 2005, www.shrm.org/hrmagazine/

CareHere physicians use exam room computers to update patient records and show patients trends in their key values such as cholesterol, blood pressure, glucose, and over 140 other values. Modern Healthcare reports that patients appreciate the service.

Putting a computer terminal in the exam room helps the physician-patient relationship according to Kaiser Permanente scientist John Hsu, M.D. When used well, computers help improve patients' satisfaction and boost their understanding about their individual conditions.

A study followed 313 patients and their reactions when eight physicians at a primary-care medical office building in the Portland, Ore., area installed terminals in their exam rooms. Physician-patient encounters were videotaped and patients were interviewed before computers were added, the month they were added and seven months later.

Patient Satisfaction Rises

In a report published in the Journal of the American Medical Informatics Association, Hsu stated that patients rating their satisfaction as excellent rose to 62.8% from 55.3%. "Computers in the exam room are a potential barrier: They can suck away the physician's attention and potentially slow things down as physicians enter data or document their activities," Hsu said. "Fortunately, we found that those two things did not happen."

Previous studies, most done more than 10 years ago, found that communication was hindered as physicians became preoccupied with computer tasks, Hsu said. But he added that these studies were done before systems became more user-friendly and when doctors were less computer-savvy.

Patient Understanding of Their Conditions Improves

Using the computer this way led to improved patient understanding of their conditions and treatment. According to the study, the percentage of patients reporting excellent satisfaction in the comprehension of their diagnosis or treatment rose to 57.3% from 46.4%.

The number of patients reporting excellent satisfaction in understanding how their physician reached their diagnosis or determined their treatment also rose, to 52.3% from 41%.

On the downside, however, patient understanding of potential side effects or complication dropped to 43.8% from 50.8%. "They understood the diagnosis and their prescribed treatment better-and how their doc got to that point-but not what they have to do," Hsu said.

He explained that patients were able to comprehend what was on the computer screen but had trouble comprehending concepts that were not, such as what effect an exercise program would have on their conditions.

Source: Modern Healthcare, www.modernhealthcare.com/article.cms?articleId=36240, 6/20/05

CareHere is a leading onsite medical clinic management firm. We are especially proud that our philosophy and systems are supported by the U.S. Dept of Health & Human Services as indicated below.

On July 21, 2004, the Department of Health and Human Services (HHS) released the Framework for Strategic Action, The Decade of Health Information Technology: Delivering Consumer-centric and Information-rich Health Care.

The Strategic Framework outlined four major goals to realize the President’s vision of health care that utilizes information technology to avoid dangerous medical mistakes, reduce costs, and improve care:

• Inform clinical practice with use of electronic health records (EHRs).
  • CareHere patient records are maintained as EHRs.
• Interconnect clinicians so that they can exchange health information.
  • CareHere's secure online system interconnects clinicians for a given client. Further, aggregate health information (stripped of personal identifiers) is analyzed for trends and critical concerns.
• Personalize care with consumer-based health records and better information for consumers.
  • CareHere Patients have online access to their lab results in an interpretative and color-coded format. Further, all patients have access to medical information customized to personal medical results.
• Improve population health through advanced biosurveillance methods and streamlined collection of data for quality measurement and research.
  • CareHere's systems use statistical regression techniques, alerts and surveillance methods to monitor individual patient and population trends.

Source: U.S. Dept of Health & Human Services, www.hhs.gov/healthit/rfisummaryreport.pdf

In many cases the past predicts the future. However, in today's efficiency driven healthcare delivery system, no one is really expecting the return of the kindly, country doctor who travels from one patient’s home to another … but what if that basic concept was tweaked a little?

CareHere Makes an Old Idea New Again

Building off the idea of an old-fashioned house call, Brentwood-based CareHere is one of a small number of providers bringing medical care directly to patients via their workplace.

Proponents of the healthcare delivery model say employees enjoy reduced or waived co-pays at onsite clinics as well as greater convenience. Employers benefit from the savings generated by promoting health and wellness, decreased claims as well as decreased absenteeism.

For physicians, the onsite clinic allows them to generate extra revenue on their day off and to practice medicine without paperwork and red tape, which is handled by someone else.

What he and co-founder Ben Baker hope to do is to provide that same kind of care to smaller companies with as few as 100 employees.

"We have proposals before companies today with over 2,000 employees but our focus is in that 100-1,500 employee range," Clevenger said.

American Retirement Corporation Goes Onsite

"American Retirement, like any other employer, is having their healthcare costs go up, and they are looking for ways to manage it better," said Clevenger.

After instituting an onsite medical provider, American Retirement realized savings from the very first quarter. Although Clevenger cautioned that savings aren't generally projected from the getgo, he said most companies would see some savings in the first year with substantial savings following in years two, three and beyond.

CareHere Services

Clevenger and Baker explained CareHere recruits the physicians, nurses, medical assistants and any other personnel needed to provide care at the employer's work site. The company also introduces employees to the onsite care concept and continually promotes the specific services offered at their workplace.

Additionally, the CareHere staff establishes vendor relations and tracks and maintains inventory at onsite clinics and pharmacies.

Clevenger stressed using the onsite physician is not mandatory and said employees are allowed to maintain choices.

However, Clevenger noted, "Many of the employees come to see the onsite physician as their primary care physician."

He added, "We don't change the plan...we don't change the network. When we recruit a physician, we make sure that physician is part of the community, part of the network and has privileges at the main hospital in the community."

Source: Nashville Medical News, Cindy Sanders, April 2004