OnSiteClinics.Org

Sherman and Fabius in JOEM

Bruce Sherman, MD and Ray Fabius MD have co-authored a new study that will be published this month in The Journal of Occupational and Environmental Medicine that addresses ROI and its relationship to on-site clinics.  This is, from our ongoing review of the literature, the only survey of return on investment worth reading.

The Authors, Sherman and Fabius should be well known to readers of The Forum, as both have  long and storied careers in primary care, worksite health and workplace clinics.  Each has contributed significantly to the idea that worksite health services are more than a clinic and must be taken within the context of the whole health care “spend” and the total health status of the population being served.

In this most recent article, entitled “Quantifying the Value of Worksite Clinic Nonoccupational Health Care Services”, the authors point out that the computation of ROI (return on investment) is inconsistent from program-to-program and that there exists no standard for this measure that is accepted industry-wide.  They further state that the employers, in a rush to achieve near-term cost control over health care, are unable to demonstrate if this goal has been achieved.  They reference one program that has had some level of credible success and which has been studied on an independent basis using rigorous standards (QuadGraphics in Milwaukee) but they note correctly that this is the only long term analytic inspection of non-occupational health care services.

The authors suggest a framework for programs to consider and offer a number of observations concerning data, data collection and the qualification of results.  Essentially, Sherman and Fabius are reporting on an emerging industry with a lack of credible evidence to support the claims of the many vendors that are stumping from industry to municipality and back with promises of two-for-one and three-for-one ROI.

This article should be on the desk of any executive that is considering an on-site offering or reconsidering a contract for continued services in the workplace.  If there is an underlying theme, it is that employer understanding of existing community health care access and quality is critical and that basic on-site services do not necessarily perform in any optimum fashion unless they are crafted as part of an overall program.