Employers increasingly bring healthcare to their workers

Employees at General Motors Co. will have access to a group of dedicated Henry Ford Health System physicians at its Warren Tech Center starting this month.

The automaker contracted the Detroit health system to provide primary care services to employees, with plans for a grand opening on July 19.

GM joins a growing list of large companies in the U.S. and across Southeast Michigan choosing to bring doctors in or near the workplace in recent years. Large employers, those with 5,000 or more employees, opening primary care clinics on site or nearby has expanded in recent years. More than 31 percent of those large employers offered primary care directly to employees on site or near site in 2020, up from 20 percent in 2019, according to data from New York asset management and consulting firm Mercer.

Locally, GM follows United Wholesale Mortgage, Rocket Companies and Amazon in offering the services. The companies are building out the clinics dedicated to employees as a means to improve primary care among their workforce, improve productivity and, in theory, save on long-term health care costs.

According to experts, these clinics may represent the future template of employer-led health care.

GM and Henry Ford Health declined to comment for this story ahead of a formal announcement by the automaker.

In February, Amazon opened three dedicated primary care offices across the region — in Westland, Royal Oak and Brownstown — for its growing workforce as part of a pilot program. The company contracts San Francisco-based Crossover Health to provide those services and has 17 operations total in Michigan, California, Texas, Arizona and Kentucky.

There, employees pay a $45-$55 fee to see a physician, depending on whether they are enrolled in Amazon's heath plan. The fee covers the visit, any services provided, blood work and any basic prescriptions. Amazon's health centers also provide mental health and physical therapy services. Those services are also available to worker dependents.

The three facilities staff 12 board-certified physicians, six therapists and a physical therapist.

Jay Edward, practice manager for Crossover Health's Detroit Amazon clinics, said the sites were created to allow Amazon employees quick access to health care. Employees can make same day or next day appointments and waiting room times are limited to five minutes or less.

Amazon's workforce — approximately 8,000 full-time workers in metro Detroit — wasn't utilizing the company's health benefits as much as in other regions, said Derek Rubino, senior program manager of Amazon's workplace health and safety special programs.

"We hand out (health) benefits on day one of employment, but they weren't widely being used," Rubino said. "We have employees who work different shifts and hours that may be outside when a standard physician's clinic is open. We viewed this as an opportunity to provide access to care in a really controllable way. We can bring (health care) to where to they work and live in a way that works for them. We can increase benefits usage by decreasing barriers."

Amazon's three clinics are open from 7 a.m. to 11 p.m. Monday through Friday and 9 a.m. to 6 p.m. on Saturday and Sunday.

Rubino said the region's high rate of emergency room use was a catalyst for Amazon's pilot program.

According to Blue Cross Blue Shield of Michigan, 44 percent of the 672,000 ER visits its members made in 2016 were avoidable and the lack of primary care is the root cause. These visits are also a major problem for employers, from a cost and productivity perspective.

"Not only are ER visits more expensive (the average claim cost for each visit is $1,368), but they can also be lengthy, which potentially means lost time at work and lower productivity," the Detroit-based health insurer said in a blog post.

Rubino called these avoidable ER visits "a lose-lose for the employers and employees."

Tracy Watts, a senior partner for Mercer's health care division, said improving productivity is the primary reason employers are opening primary care clinics.

"If an employee needs to see a doctor, employers want it to happen as quickly as possible with the least amount of downtime as possible," Watts said. "This is an effective way to streamline primary care for employees so they have little time away from work as possible, thus increasing productivity."

Pontiac-based United Wholesale Mortgage opened its on-site primary care clinic in October 2016 — one of the first in the region to do so. Its clinic, which is operated by Troy-based Salta Direct Primary Care and employs two physicians and five physician assistants, sees about 27 percent of UWM's 9,200 employees each month, or about 2,500 to 3,000 visits monthly, said Laura Lawson, UWM's chief people officer.

Employees pay a $10 fee per visit. But the clinic does not have a pharmacy or perform labs on site and is only available to team members, not dependents. The clinic is staffed from 8 a.m. to 8 p.m. with an available 24-hour hotline.

Lawson said with a median age of 32 years old, UWM's staff doesn't typically use primary care as often as older populations. Opening the clinic increased preventive care and allowed the mortgage wholesaler to more strategically manage its workforce.

"Everyone used to come into work sick (before COVID-19) with a cold or flu or whatever," Lawson said. "Now that person can easily see a doctor on site and get diagnosed and sent home, allowing us to prevent the spread. And we basically run a small city here with 9,200 employees. So whenever there is a slip and fall on ice in the parking lot or an asthma attack, we can address it."

Employers are also looking to reduce health care spending through the use of primary care clinics.

Health benefits are expected to rise 5.3 percent in 2021 to $14,769 per employee, an increase of $197 from last year, according to a recent survey of 122 large U.S. employers that pay benefits for 9 million people by Business Group on Health. Employers cover about 70 percent of that cost.

For an employer the size of General Motors, that means health benefits would rise by more than $17 million this year for its 86,300 U.S. employees. That's not even counting dependents.

Rubino from Amazon said the pilot program hasn't revealed any clear cost savings, but it's too early in the program to accurately predict.

"The cost savings is fairly long-term thing, but health is one of those win-win scenarios," Rubino said. "An employee would rather be healthy. That benefit is really obvious from a company perspective. Increased employee satisfaction means they stay longer. If we can prevent longer-term costs by catching things early, we can definitely save money. That's the hope, at least."

Lawson from UWM said the cost savings have yet to pan out, calling the investment a break even.

"We haven't raised our employees' contributions to match Blue Cross Blue Shield increases for the past five years, so when we see any savings it's pretty minor," Lawson said. "But we're quarterbacking their care. We're helping them simplify the complexities of health care and creating a better environment. This is really expensive. But so is health insurance. If we see cost savings along the way, it just grounds the importance of this clinic."

Watts said the cost savings will come as more and more companies turn to onsite or near site clinics or partner with offsite direct primary care providers.

"Primary care always has been and will continue to be high value care," Watts said. "The way people access it will continue to evolve. The more people that use it, the better the return on investment is. I don't have any examples of anybody that is unhappy with this model."