Worksite Wellness Clinics and Reduction of ER Visits: Good News for Employer Health Plan Costs

by Robin E. Kobayashi, J.D., LexisNexis Legal & Professional Operations

Emergency room visits and costs are on the rise in the U.S. and expected to get worse with Obamacare according to a recent report which shows people with Medicaid (many of whom have obtained coverage under Obamacare) use ER more often than uninsured individuals. Complicating this picture are the ridiculous high costs of ER visits where one stitch can cost you $500. So you can bet that employers are itching for more concrete evidence of, not just how worksite wellness clinics can substantially reduce the number of ER visits by their employees, but also the dollar-and-cents savings to employer health plan costs. A new study published in the Journal of Occupational and Environmental Medicine shows how employers may be able to reduce their health plan costs as a result of a reduction in ER visits by employees due to a worksite wellness center.

How the Study Was Set Up

The study covered a period of eight years—before and after the opening of an employee wellness center at Johns Hopkins Hospital (JHH) in Baltimore. The employees at JHH made up the test group.

The control group consisted of the employees at nearby Johns Hopkins Bayview Medical Center (BMC), which didn’t have a worksite wellness clinic during the test period.

Employees at both JHH and BMC—nurses, administrators, paraprofessionals, and support staff—received similar health plan benefits under the Johns Hopkins Employer Health Programs (EHP).

The study examined the number of ER visits by employees at both JHH and BMC that didn’t result in a hospital admission. The study concentrated on ER visits for episodic or acute care and not for chronic conditions.

While some of the results of the study were expected, others were surprising.

Key Facts and Findings

The worksite wellness clinic at JHH provided free services to its employees from 7 a.m. to 4 p.m., Monday to Friday; however, the JHH employees must pay for laboratory, x-ray film, and pharmaceutical costs.
The JHH worksite wellness clinic assessed and treated 2,600 patient visits on average per year, with the majority of cases involving low to medium medical complexity.
The most common medical conditions treated by the JHH worksite wellness clinic were ear, nose and throat, respiratory, ophthalmologic, skin, and urinary tract.
Only 1.5 percent of the individuals treated at the JHH worksite wellness clinic were referred to ER for further assessment and treatment; however, whether or not the JHH clinic users would have actually gone to ER if a clinic didn’t exist remains an open question and wasn’t studied.
The highest users of the JHH worksite wellness clinic were maintenance, dietary, transport personnel (primarily hourly workers); treatment of episodic medical conditions at the worksite wellness clinic had a greater effect on the lowest paid members of the workforce.
Women outstripped men in utilizing the JHH worksite wellness center, 87 percent to 13 percent; employers need to take more steps to encourage men to utilize a worksite wellness clinic.
The median age of employees using the JHH worksite wellness center was 40.2 years.

JHH Employees With Worksite Wellness Clinic

JHH employees overall: The number of ER visits during a month decreased from 2.5 percent (preclinic period) to 2.1 percent (postclinic period)—a 16.3 percent relative reduction.

JHH employees in the high user clinic group (maintenance, dietary, transport personnel): The number of ER visits during a month decreased from 5.1 percent (preclinic period) to 4 percent (postclinic period)—a dramatic 21.8 percent relative reduction.

BMC Employees With No Worksite Wellness Clinic During the Same Time Period

BMC employees overall: The number of ER visits during a month decreased from 2.0 percent to 1.9 percent—a 7.2 percent relative reduction.

BMC employees belonging to maintenance, dietary, transport personnel group: The number of ER visits during a month decreased from 3.3 percent to 3.1 percent—a 7.7 percent relative reduction.

Adjustments Made to Study

The authors made several, careful adjustments to their study. For example, adjustments were made such that the reduction in ER visit rates could not be attributed to health insurance co-payment changes in the EHP health care plan. As the authors of the study observed, increasing co-payments for ER visits as well as establishing high-deductible health plans have both been shown to decrease ER visits overall.

Another adjustment to the study involved the fact that women made up 77.1 percent of the workforce at JHH and 81.4 percent of the workforce at BMC. This variable was controlled when determining that women were the predominant users of the worksite wellness clinic in question.

The authors, however, didn’t control for the use of other urgent care centers and facilities near JHH or BMC which could treat for episodic medical conditions. But since JHH (the test group) and BMC (the control group) were within a 2.6 mile radius of each other, the authors reasoned that employees at both JHH and BMC could have used these other primary care centers.

Estimated Cost Savings for Employer’s Health Plan

The study sought to determine the financial effect on an employer’s health care plan as a result of a reduction in ER visits due to a worksite wellness center. It estimated the cost savings related to the JHH worksite wellness clinic at approximately $40 per member per year and more than $210 per member for the high user clinic group.

The authors of the study explained that when the JHH worksite wellness clinic was established, the costs of assessment and treatment at the clinic were expected to offset the employer’s health plan’s expenses for diagnostic and treatment costs of a visit to an outpatient, urgent care facility or physician’s office for patients involving low to moderate medical complexity. The study found that reimbursement by the employer’s health plan was approximately 10 percent of the amount it would have to pay for an ER visit, thereby suggesting that the worksite wellness clinic had a “greater effect on medical costs than previously anticipated.”

Author Robin E. Kobayashi, J.D., Workers’ Compensation Practice Area Lead at LexisNexis. She is the site coordinator for the LexisNexis Legal Newsroom Workers’ Compensation Law. She has been a Sr. Legal Editor at LexisNexis specializing in workers’ compensation law for over 28 years. She also serves as the Editor-in-Chief of theLexisNexis Workers’ Compensation eNewsletters and the Co-Editor-in-Chief of Workers’ Compensation Emerging Issues Analysis, a 50 state survey of workers’ comp legislation and trends. Contact: Robin.E.Kobayashi@lexisnexis.com