Competition for providing onsite health care is heated.

When Ray Fabius, MD, talks enthusiastically about the boons of full-service onsite health care for an organization's employees, he readily admits to a potential conflict of interest.

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Until it was acquired by Walgreens last year, Fabius served as chief medical director of Take Care Health Systems, a leading provider of integrated worksite occupational, wellness, health promotion, fitness, physical therapy, behavioral health, primary care and pharmacy programs. Fabius now holds the title of strategic advisor to the president, Walgreens Health & Wellness Division, Take Care Health. It's his role to tout the product line.

Clearly, though, he believes in what he preaches. And he's also quick to acknowledge that when it comes to serving up prix-fixe, soup-to-nuts workforce health care programs for employers--or for that matter, letting them mix and match from the menu a la carte--Take Care Health is not the only chef in the kitchen.

Two major competitors, he notes, are Concentra, based in Addison, Texas, and Comprehensive Health Services (CHS), headquartered in Reston, Virginia.

Concentra, which operates onsite medical services at more than 250 work locations nationwide, recently announced a pact with Aetna to establish a physician-staffed onsite center at any company that offers an Aetna health insurance plan.

Concentra and Aetna cite a 2005 study that shows such a program can save an employer $5 to $6 for every $1 invested. (Occupational health researchers have, however, questioned the rigor of data collection supporting such analyses.)

CHS says it manages and operates some 90 onsite clinics for Fortune 1000 employers and government agencies, and is planning to open five more this year. That includes an onsite facility serving 4,500 employees at the new downtown Chattanooga corporate office of Blue Cross Blue Shield of Tennessee. CHS is partnering with CVS Caremark to provide onsite pharmacy services there as well.

Two Philadelphia hospitals recently contracted with Take Care Health to provide services to employees. Children's Hospital of Philadelphia (CHOP) gives a one-time $130 health insurance premium rebate to any of its 8,700 benefits-eligible workers who fill out a health risk assessment. Based on the results, they receive appropriate personalized lifestyle coaching and disease management oversight.

In March Albert Einstein Medical Center opened a clinic under Take Care auspices offering testing, vaccinations and physical therapy as part of a comprehensive LiveWell program for 7,000 employees.

One argument in favor of using outside vendors, explain human resources executives at both hospitals, is that employees are reassured their health status will not be disclosed to their bosses.

Win-win

In Branson, Missouri, 168-bed Skaggs Regional Medical Center provides occupational health services to several local employers, including the Silver Dollar City theme park and associated attractions.

There Skaggs staffs an onsite medical clinic with a family practice physician, an LPN and an office administrator on duty five days a week to diagnose and treat the routine ills of 1,850 employees and their family members.

Called Mary's Well House (in honor of the doyenne of the Herschend Family Entertainment Corporation, which owns the park), the clinic is equipped to take X-rays and lab test samples. Employees pay $15 per visit, their family members $20. Although the park closes for the winter the clinic remains open year-round. It registers almost 100 visits a week.

"The response has been fantastic!" exclaims human resources director Deanna Partridge. "We're really proud of it. It's a win-win for everybody. Most of our employees are seasonal workers, but they're offered rehires and we have a 97-percent retention rate."

Herschend also operates the Dollywood theme park co-owned by country-Western singer Dolly Parton in Pigeon Forge, Tennessee. There, likewise, an onsite family medical center serves some 2,200 employees for a $10 copay per visit. (Dependents become eligible after a worker has been at Dollywood for three seasons, and have a $15 co-pay. Retirees who've logged 20 years can continue to receive primary care at the center too.)

"It's the most popular thing we've ever done for our employees," declares Dollywood human resources director Jay McNeill. "Even folks with insurance use it because they love the convenience. Mostly the doctor and her husband--he's a nurse practitioner--treat flu, colds, sprains ... but they've saved the lives of several people who had chest pains.

"Physicians love this type of thing," he continues. "There's no insurance to deal with, no hassle, no paperwork. I'm personally surprised this hasn't grown faster because of all the cost-shifting you avoid. I don't know if you can ever really measure return-on-investment, but it has certainly helped us with recruitment and retention."

Dollywood contracted with Take Care Health to run its family health center in 2002, then put the contract out for competitive bid several years later at the urging of a local hospital, says McNeill.

"Their bid was so much lower that we had to give it consideration," he recalls. But closer comparison revealed that many basic services like vaccinations had not been included. "By the time we got apples to apples it turned out the cost wasn't much different."

"We had stats on how we were getting patients healthier," says Take Care account manager Jane Mingey, referring to that negotiation. "We could project savings and improvements." Typically, she explains, a commercial vendor bases its bid on analysis of the potential client's medical claims and guarantees of better clinical outcomes (percentage reduction in blood glucose levels among diabetics in the covered workforce, for example), patient and provider satisfaction scores and predicted ROI. If targets aren't met there's a penalty.

"The hospital [we were bidding against] tracked visits," she notes. "It seemed as if they were trying to drive volume. And they were more procedure oriented. With us an employer has fewer hospital admits."

Take Care Health kept Dollywood's business.

Ray Fabius worries that "keeping beds filled and providers busy is too often the mantra in health care organizations." In communities where they are the biggest employers--and that's a lot of communities--"there's the potential for stealing workers from the workforce for marginal treatments," he points out.

"That's the secret we can deliver to physician executives," he proposes. "It's within their power to influence the productivity of the workforce they serve in positive and in negative ways."

David Weber

Health Care Freelance Writer

Mendocino, California