Employers jump into providing care as health costs rise


KOKOMO, Indiana (AP) — Autoworkers in this blue-collar, central Indiana city have an eager helper waiting to pick up the bill at their next doctor visit.

Fiat Chrysler is offering free health care for most of its employees and their families — about 22,000 people — through a clinic the car maker opened this summer near one of five factories it operates in the area. The company pays for basic care like doctor visits and consults with a dietitian and even an exercise physiologist. Workers don’t pay a cent, not even a co-pay.

The idea: Spend more now to improve care and eventually pare the more than $100 million that Fiat Chrysler Automobiles pays annually for health care, just in Indiana.

“We looked at how do we change the health care delivery system, that’s really what employers are asking,” Fiat Chrysler executive Kathleen Neal said.

Corporate America is jumping deeper into the care its workers receive beyond just giving them insurance cards and a list of doctors they can visit. Companies are opening clinics on or near their worksites or bringing in temporary setups to make sure their employees get annual physicals.

In many cases employers are offering free primary care or charging only a small fee. Many believe the cost is worthwhile because they can improve employee health and cut even bigger bills in the future that stem from unmanaged chronic conditions like diabetes or unnecessary emergency room visits.

Offering convenient care can also help attract new workers and cut down on time away from the job. But this shift means workers will have to change how they use the health care system. And companies, which don’t see individual medical records, have to patiently wait for some potential benefits from their investment like a drop in health care costs.

“It is really, really hard to change behavior,” said Carolyn Engelhard, an associate professor at the University of Virginia’s medical school who studies health policy.

Big companies have long offered services to help employees recover from workplace injuries, and now more are delving into primary care.

Fifty-six percent of large employers will have on-site or nearby health centers by 2019, up from 47 percent in 2016, according to the National Business Group on Health.

Most of the businesses surveyed by the nonprofit, which represents large companies, have 10,000 employees or more. But benefits experts also see this trend in smaller businesses too, with some companies joining forces to pay for a nearby clinic that they share.

Office buildings also have started adding clinics to attract tenants that want the convenience for their employees, according to Dr. Jeff Dobro, a partner with the benefits consultant Mercer.

Mattress maker Serta Simmons Bedding started rolling out mobile health clinics to all 28 of its U.S. factories a couple years ago to help its largely male workforce get annual physicals, with the company covering the cost.

“Most people just don’t get their screenings, and a lot of men just don’t have a relationship” with their doctor, said company executive Steven Wilkinson.

Fiat Chrysler opened its clinic after learning that 40 percent of its employees in the Kokomo area didn’t have a primary care doctor, and many defaulted to emergency rooms for care that wasn’t dire.

Company spokeswoman Val Oehmke declined to say how much the clinic cost to build, but she said Fiat Chrysler expects to make back what it spent in about two years by improving employee health and cutting medical costs.

The health center comes with exam rooms, an X-ray machine and space for minor procedures. Aside from a small memorial photo of former Fiat Chrysler CEO Sergio Marchionne on a waiting room table, few signs inside the clinic connect it to the hulking transmission factory nearby.

The carmaker pays a local hospital operator, St. Vincent, to run its clinic exclusively for employees and family members.

Dr. John Lynch spent almost an hour with a patient during a recent physical. That compares to the 10 or 15 minutes he used to get once or twice a year in other practices.

“It was frustrating that I couldn’t do more for them,” he said.

Forklift operator Amanda Chipps took her toddler, McCoy, to the clinic after he developed a fever and a rash and she couldn’t get in to see their regular doctor. Chipps said that visit felt more like an annual checkup. Before eventually prescribing antibiotics, a doctor and nurse asked about McCoy’s medical history, diet and personality.

“They were really just getting to know … everything about him,” she said. “It was just real nice, a different setting from most doctors’ offices.”

United Shore Financial Services opened a similar clinic in its suburban Detroit headquarters for its 2,600 employees a couple years ago after executives saw workers coming in sick during flu season. The clinic logged about 4,200 visits in 2017, its first full year.

Account executive Sean McHugh said he seeks clinic help when back trouble flares up during the day. That saves him from losing time by driving home for care and then back to work.

“It really makes the work environment here appealing because it gives you your time outside of the office,” the 36-year-old said.

But these clinics can catch on quickly, said David Keyt, a Mercer executive who works with employers to set them up. He said having clinics on or near the worksite removes two big hurdles — cost and convenience— that prevent people from getting care.

“What we’re trying to get to is the provider-patient relationship and all the barriers that prevent that … from happening,” he said.

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Flu vaccine can:

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DOT Physicals

Troops’ quick response saves woman’s life

Photo By Airman 1st Class Jonathan Padish | U.S. Air Force Maj. Bryan Mathieson,… read more

MOLOKAI, Hawaii — The first day of a no-cost health clinic provided by members of the U.S. military at the Mitchell Pauole Community Center started simply enough. The warmth of a bright sun was cooled by a warm breeze that meandered through the clinic. Community members slowly filtered in to the building to be seen by providers while others sat by waiting to be seen. All seemed like a quiet summer Sunday afternoon until a woman, who came to the clinic for a vision screening, began to say that something felt wrong. In fact, something was very wrong. The woman was having a cardiac episode, and she needed immediate medical assistance.

On August 12, service members participating in the Tropic Care Maui County 2018 Innovative Readiness Training mission reacted quickly and saved the woman’s life.

“This elderly lady came in for a vision screening,” said U.S. Air Force Lt. Col. Doug Sutton, a clinical nurse assigned to the 158th Fighter Wing. “Her past medical history was conducive with cardiovascular disease. As she was sitting there, she started clutching her chest. We ask her what’s wrong, and she says, ‘it feels like someone is stepping on my chest.’ And we know that’s one of the classic signs of a cardiac condition going on. We asked Col. Bray to come out, and he started assessing her.”

While she was being assessed, the woman looked ashen despite her typically tanned appearance.

“She didn’t look too good, to be honest,” said U.S. Air Force Maj. Bryan Mathieson, a nurse practitioner assigned to the 181st Intelligence Wing. “Her face was as gray as her hair.”

Suddenly, the service members assigned to the Molokai clinic for the Tropic Care mission found themselves in the midst of a real-world, medical incident.

“It was a surprise visit,” said U.S. Air Force Col. William Bray, the commander of the 181st Medical Group of the 181st Intelligence Wing. “So we had to do what we could with what we had.”

Bray assessed the situation and determined the woman was having a cardiac episode. Bray was able to make that determination thanks to the actions of U.S. Air Force Maj. Bryan Mathieson and 2nd Lt. Brandon Wilmer.

“They both have experience in the emergency room,” said Bray. “Maj. Mathieson is the one who stepped up and gave her aspirin. His training kicked in. Both Maj. Mathieson and 2nd Lt. Wilmer were key because they are critically trained in the ER. Their natural instinct is to just roll.”

Mathieson and Wilmer’s actions played a critical role in helping the woman, who appeared to need immediate medical intervention.

“It happened just like that,” said Sutton. “They were calm and cool, and they just reacted. Everyone’s training kicked in, and they did their job perfectly. And the outcome was really good.”

The service members’ response to the incident did not stop at the clinic. U.S. Navy Cmdr. Jeffrey Loh, a nurse whose mother grew up on Molokai, went with the woman to the hospital.

“It just wasn’t right to put them in a car and tell them to drive to the hospital,” said Sutton. “So we sent Cmdr. Loh along with her in the event they needed to stop the car and administer CPR.”

Loh’s presence was instrumental in facilitating the woman’s transfer to Molokai General Hospital.

“The woman and her daughter, who was accompanying the woman, identified with Cmdr. Loh from a cultural aspect,” said Sutton. “They were very comfortable with him. It seemed natural for him to gain that trust and build the interpersonal relationship, which made them agreeable to going to the hospital for the level of care she needed after she initially refused to go.”

Had the service members not reacted the way they did, the outcome could have been dire.

“She was having angina, which happens where the coronary arteries are squeezing and cause chest pain,” said Sutton. “She may have dropped over had she not been taken to the hospital.”

Thankfully, the woman received the care she needed.

“The daughter followed up, and the woman was released,” said Bray. “She’s doing well presently. We’re always happy when the outcome is positive.”

Despite the incident, the service members downplayed their role in taking care of the woman.

Medical professionals see people experiencing chest pain all the time in the ER, said 2nd Lt. Brandon Wilmer, a clinical nurse assigned to the 181st Intelligence Wing. It did not seem like anything out of the ordinary when it happened.

Service members were able to save a woman’s life despite limited resources at the temporary medical clinic, which had only been set up the day prior.

“We definitely put the ‘I’ in Innovative Readiness Training,” said Sutton. “We used the resources that we had quickly, efficiently, and effectively to get her to the additional level of care she needed.”

The service members, by relying on their military and civilian training, worked as a team to quickly access the situation and ensure the woman received the proper level of care. What started as a normal day became urgent in a moment, and the service members did what they know best: administer medical care to save a life.

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