In the realm of workers’ compensation risk and injury management, an increasing number of employers are seeking to control costs and improve efficiencies by implementing on-site care teams and clinics. While the investment can be significant, many are coming to understand that the benefits outweigh the costs in terms of both employee satisfaction and outcomes.

“When there is an employed physician providing medical care on site, this provider can not only assess an employee’s injury but closely follow those employees as they are referred out to more specialty care, or have those specialists come on site to provide those services,” said Ryan Roberts, vice president and director of health care and social services, IMA Financial Group. “This physician can also work closely with the risk management team on that employee’s claim, their return-to-work status and how to prevent that injury from reoccurring.”

On-site Care Grows Post-Pandemic

Given these benefits, it’s no surprise that on-site care in some form has exploded, especially post-pandemic and in the face of rising inflation, which affects health care and its delivery on a lag that is just now coming to the fore.

“The biggest trend is growth, certainly in the past three years or so. The pandemic has fueled awareness among clients that the on-site provides them with the flexibility to do all kinds of things,” said Jeffrey Kirkpatrick, clinical director of strategic accounts for on-sites at Concentra. “Even before that, companies are recognizing the value of investment (VOI) is even bigger than any kind of number-crunching ROI they could come up with for an on-site.”

The growth in adoption is indeed rapid, especially among large employers. The Business Group on Health 2021 Large Employers’ Health Care Strategy and Plan Design Survey, which studied the growth of employers implementing and considering on-site care, found that a full 73% of large employers were considering on-site care.

Sixty one percent had already implemented some form of it, despite the pandemic bringing more workers into home offices. The survey respondents are risk managers overseeing employee populations most commonly numbering between 10,000 and 50,000, but in some cases in excess of 100,000. The most common industries are somewhat expected — retail and utilities, where on-site work is still the norm and injuries are common.

The trend is just as remarkable among smaller businesses. The 2021 Mercer and National Association of Worksite Health Centers (NAWHC) survey found that a third of employers with 5,000 or more employees had implemented on-site resources for primary care.

“The pandemic has fueled awareness among clients that on-site provides them with the flexibility to do all kinds of things.” — Jeffrey Kirkpatrick, clinical director of strategic accounts for on-sites, Concentra

Kirkpatrick explained that on-site care brings value, especially for the “gray area” patients — those who need more than a bandage but less than a hospital visit: “Risk managers can trust that the on-site is doing what’s medically necessary.”

For example, new hires that are experiencing soreness due to standard job activities may be tempted to seek emergency care, whereas an on-site can provide preventative care like stretching as an orientation to address the issue without driving up claim costs and before it becomes a reportable injury. These types of services are a boon to both sides of the health equation.

“We’ve seen in the industry an improved or enhanced quality of output from employees, because they feel like you’re investing in them; it’s just another way to bring value,” said Shawn Waters, director of case management in the clinical services division of Optum.

“In recent years, companies that have taken this type of special interest in their employees through on-site holistic care options have moved to having a multidisciplinary team on site to do preventative disease screenings and immunizations clinics,” she added. “Wellness programs at organizations are common now, and they are doing health assessments on site, and as it relates to the injured worker, we have options for post-injury care.”

Tying on-site care to wellness incentive programs has benefits, as the types of screenings they offer can reduce health care costs overall while acting as preventative care for occupational injury and illness. Given the typical friction associated with workers’ compensation injuries, melding all health care into a single convenient service can reduce litigation and improve outcomes.

Aside from the advantages of having clinical staff on site for quick diagnosis and treatment for workplace injuries, on-site case managers can also offer a valuable resource for companies by ensuring the injured employee is immediately connected to providers who can help develop the best return-to-work treatment plan.

Case managers who work on site become specialized in the types of injuries that often occur in that particular workplace, helping them develop strong relationships with the best providers and specialists in the area. They also strongly advocate and support employees by emphasizing the importance of care plan compliance, ensuring they attend appointments and follow-up visits.

“From the employer’s perspective, they see value in the face-to-face contact on a daily basis and believe these positions are more customizable and flexible in their service delivery,” said Helen Froehlich, senior vice president, utilization management at Genex.

“For the injured employee, they have a case manager on site who knows their industry and their job. These case managers know the worksite team and can discuss and develop modified duty options to help integrate the injured employee back to the job,” she said.

Pandemic Fuels Telemedicine, Additional Services and Expertise 

The pandemic made telemedicine a necessity in the care of injured workers and its growth tightly tracks with that of on-site clinics, who often offer telemedicine visits with general practitioners or specialists within them. 

A U.S. Government Accountability Office report from late 2022 analyzing Medicare data found that telehealth use increased tenfold from about 5 million services (in April-December 2019) to more than 53 million services during the same months in 2020. While the demographics are not the same, Medicare’s functionality as a payor makes this data relevant for workers’ compensation, which has invested heavily in telemedicine services including triage and follow-up visits in the last decade. 

For her part, Waters believes that telemedicine as a service for injured workers and the entire employee population is ripe for expansion.  

“It allows for a more seamless transition of data, and having that as an option onsite for employees is a benefit and a trend that we’re moving towards especially post-pandemic,” said Waters. “This type of transformation is critical for the healthcare industry, I expect it to continue in the near future.”  

Privacy Concerns

Jeffrey Kirkpatrick, clinical director of strategic accounts for on-sites, Concentra

Despite the benefits, employee adoption is key to making the on-site investment worthwhile, and the primary barrier to employee adoption is likely to be privacy concerns.

“The privacy part is critical,” said Kirkpatrick. “There’s always the potential pitfall where the on-site team could be perceived as the company doctor, or conversely, where the employer thinks that the on-site team is just doing what the patient wants. It all goes back to trust and consistency and experience.”

Aside from internal advertising and ensuring that the on-site team is acquainted with the employee population they intend to serve, privacy concerns can also be allayed by utilizing third-party vendors with expertise in on-site services.

“It will then be crucial that contracts include the appropriate indemnification language and specify overall management services,” explained IMA’s Roberts. “Employers should also work closely with their risk and human resources teams to ensure that employee medical information remains protected.”

No matter the administrative route, these services also deliver a vital fringe benefit writ large.

“Over and over again, clients are telling us that, in a competitive job market, being able to tell prospective hires that they have an on-site clinic to provide basic services as well as workers’ comp is a big competitive edge for hiring,” Kirkpatrick said. &