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QUALITY: A Medical Home -- at the Office

You've heard of a medical home? What about a medical home-away- from-home, or more specifically a medical-home-at-the-office?

Stacey Burling at the Philadelphia Inquirer writes about the national trend of having company doctors or company clinics to provide primary care, wellness, screening and related services at the workplace. The idea is to keep workers healthy—and keep them out of the emergency room when they are sick. And, they hope, put a dent in rising health care costs. Bunting writes of Cardone Industries, which remakes auto parts:

Too many of its 4,000 employees, a melting pot of immigrants from dozens of countries, lacked primary-care doctors. Rather than deal with problems early, they'd wait until they were really sick, then head for emergency rooms, the priciest place to get health care. On top of that, a small but growing number of workers was turning down the company's health insurance plan because it was too expensive.

Cardone has responded with an onsite clinic staffed by doctors from the Holy Redeemer Health System. It will serve Cardone workers as well as their families. The hope is that the clinics will improve worker health, control costs, and increase worker productivity, both by catching and controlling medical problems before they get serious and by making it quicker and more convenient to see a doctor during the work day.

It's part of a growing trend attracting players ranging from Walgreen Co. to Johns Hopkins. There isn't a lot of data yet on the costs, but here's a glimpse of Toyota's experience:

Toyota opened an ambitious center for its employees in San Antonio, Texas, in January 2007. Two doctors and a nurse practitioner provide primary care. There is also dentistry, X-rays, optometry, physical therapy, and a pharmacy that fills 150 prescriptions a day. It has been so successful that Toyota is now opening smaller clinics at two other locations, said Ford Brewer, Toyota's medical director in North America.

Toyota paired the San Antonio center, which now provides half the primary care to 4,000 employees, on-site suppliers and their families, with a restricted network of hospitals and specialists who scored in the top 25 percent on quality ratings. In exchange for having fewer competitors, the hospitals and specialists gave Toyota a 20 percent price break.

Toyota doesn't save money on the clinic itself, but by spending more on primary care, it is bringing down costs on the overall health package.

We like stories like this, partly because we believe that it is possible to save money by improving quality, by spending smarter. And we like it because we think fixing our health care system is going to take a lot of innovation, a lot of creativity, a lot of willingness to try different things and see what works in what setting. Besides, as any working parent trying to squeeze in some routine care between the workload and the carpools and the weekend sports and the childcare headaches can tell you—location, location, location.