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On-site medical business accelerating quickly

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The NTN Driveshaft Clinic on Goeller Rd. in Columbus.
The NTN Driveshaft Clinic on Goeller Rd. in Columbus.

Blair Fuller works at a medicine dispensing workstation on Friday, Jan. 31, 2014 at the NTN Driveshaft Clinic.
Blair Fuller works at a medicine dispensing workstation on Friday, Jan. 31, 2014 at the NTN Driveshaft Clinic.

Three weeks after its grand opening, an on-site health clinic operated by IU Health Business Solutions for insured employees of NTN Driveshaft and their families is reportedly doing a brisk business.

Jill Mercer, business development manager of the Indiana Health system division that runs the 2,100-square-foot clinic on West Goeller Boulevard, said the concept of bringing basic health care directly to an individual company’s doorstep is experiencing a meteoric rise statewide.

IU Business Solutions now runs 35 such clinics across Indiana, including one in north Columbus for the Bartholomew Consolidated School Corp., as well as the west Columbus clinic for NTN Driveshaft. NTN’s site operates 24 hours per week and could add hours if usage demands it.

“Our on-site clinic business has grown 20 percent a year each of the past five years, and it shows no signs of slowing down,” Mercer said.

“We’ll add five or six more by the end of the year, basically one every couple of months.”

IU has sites across Indiana, as well as in Illinois (near Chicago and across the border from Terre Haute) and for particular clients that employ workers at sites in Ohio and Michigan.

Elsewhere, Peter Dunn, principal executive with 5-year-old Activate Healthcare of Indianapolis, said the on-site medical business has been accelerating since his company started in 2009.

The growth trend in Indiana matches an equally brisk wave of new business nationally as more employers turn to clinics, in-house wellness programs, employee education and early intervention techniques to control medical insurance costs.

Two years ago, Activate Healthcare, led by Dunn (a former Steak ’n Shake CEO), raised nearly $1 million from private investors to expand operations. The company now serves 50 employers and operates nearly 20 clinics. In some cases, employees and their families representing multiple clients get treated at the same site, Dunn said.

Activate has clinics in Seymour, Bedford and Bloomington among other locations right now. It doesn’t have any clients in Columbus yet, however.

Manufacturers led the way in developing on-site clinics as a concept more than a decade ago, in part as a way to treat workplace injuries and manage their worker compensation programs.

Lately, though, the concept has blossomed to include white-collar businesses, insurance companies taking care of their own staffs, school districts trying to keep their teachers well and a diverse collection of other companies.

Activate runs clinics for city and county governments, nonprofit enterprises and a distribution company in addition to manufacturing companies and others, Dunn said.

Dunn and Mercer said 75 to 80 percent of their clients are self-insured, meaning the employer must make up the difference when medical claims filed by patients cost more than monthly premiums bring in. That motivates employers to monitor expenses feverishly, and clinics have become one weapon in their cost-containment arsenals.

On-site clinics typically work something like this:

Doctors, nurse practitioners and medical assistants are hired to staff the clinics. Employers pay a flat fee to the clinic operator to provide basic patient services and medical supplies each month. Many clinics have in-house pharmacies to provide basic medicines at low or no extra cost to patients treated there.

Clinic operators such as IU Health or Activate have the option of hiring their own physicians, or they can sign partnership deals with a hospital in the community to provide primary care doctors. Those doctors make referrals when necessary to specialists to treat serious illnesses.

In Columbus, IU Health partners with Columbus Regional Hospital for physician services. In cities where Activate operates, it typically allows patients to go to any hospital covered by the client’s insurance plan. Dunn said the fact that his company is independent of any particular hospital network is actually a sales advantage for Activate.

Patients, in effect, can shop around for the best quality care at lowest possible cost whenever there are multiple hospitals in town, he said, adding that Activate isn’t captive to any particular institution.

Many clinics also maintain online scheduling systems that allow patients to access a secure site to make medical appointments — in many cases, the same day or next day. Such quick service keeps a company’s patients out of high-cost hospital emergency rooms, and saves money in the long run, Mercer said.

There are also a variety of wellness programs — dietary advice, stop-smoking classes and one-on-one or group health coaches — offered through the clinics. Many do heath risk assessments for patients and then follow up to keep individuals on track to prevent serious illness.

In IU’s case, its clinics typically have in-house pharmacies with a stock of often-used generic medicines, and it buys in bulk for all 35 of its clinics from a Carmel, Ind.-based pharmacy partner, Mercer said.

“By purchasing in bulk we get preferred pricing, and we achieve significant savings,” the IU business development manager said. “Our role as clinic manager is to negotiate the best rates we can.”

In Columbus, the clinic gets its lab work done at Columbus Regional Hospital, and they give me the best lab pricing of anyone in the state,” Mercer said.

At the NTN Driveshaft clinic, patients don’t have to pay for office visits. If a medical problem is more complicated, patients are sent to specialists, and regular insurance coverage with deductibles, co-pays and other expenses kicks in.

The 3-week-old clinic — called the NTN Health & Wellness Center — has been outfitted with four fully equipped exam rooms and a waiting area. It is located in the Woodcrest Plaza office/retail area across from Tipton Lakes Athletic Club.

Wellness plans also play a major role in reducing costs, Mercer and Dunn said.

“People are going to be more proactive in taking care of problems sooner rather than later,” Mercer said. “A client company can save a lot of money if patients stay compliant taking their medicines, become engaged with a health coach or take stop smoking or weight-control classes led by a nurse practitioner.”

Dunn said a company that signs up to let Activate run an on-site clinic for them can expect from 15 to 25 percent savings after a year.

Fuld & Co., a New York-based research firm that has studied in-house and satellite corporate clinics, estimates medical savings of 10 to 30 percent for companies that take part.

“Employers are increasingly realizing they have to better manage both short- and long-term health issues to properly address the issue of costs,” the Fuld study said. “New integrated wellness and disease management programs focus on individual employees and encourage people to adhere to medication regimens and other routines.”

As with anything in health care — especially in the wake of major federal reforms — the future of on-site clinics isn’t guaranteed.

But Mercer said IU Health’s growth rate in the niche shows no signs of abating, even though other companies have entered the field and made competition increasingly fierce over the last few years.

“In 2008-2009, our business really took off, and it hasn’t looked back,” she said.

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