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Why Your Company Needs Worksite or Near-Site Direct Primary Care


Guest: Larry Borres

Narrator (00:00):
Welcome to 360 degrees of healthcare with Dr. Stan an in depth. Look at our industry from our very own chief medical officer who will talk with other medical and industry professionals on the changing and evolving landscape of the healthcare system from the inside.

Stan (00:21):
Thanks for joining us. My name is Stan Schwartz. I’m an infectious diseases physician with decades of experience in healthcare. As a student, a teacher, a fellow, a researcher, a practicing physician in both solo and group practices, a health system executive, and now a healthcare entrepreneur. And as I get all older as a patient, I want to share my 360 degree view of healthcare with you. My thanks to zero studios for support of this podcast. My guest today is Larry Boress. He’s the executive director of the national association of work side health clinics. We’ll go in depth into what employers and benefit consultants need to know about employer sponsored direct healthcare. Larry, thanks for joining us and sharing your expertise. Please tell us about yourself.

Larry (01:11):
Well, thanks very much and, uh, nice to always be with you, Stan. Uh, yeah, so, uh, I started my career, frankly, back, uh, in, uh, 19, uh, 78 working for the Illinois state medical society. Looking after the interest of doctors spent 17 years there, uh, and then jumped the fence from the, uh, health provider side to the purchaser side of healthcare. When I joined a Midwest business group on health in 19, uh, 91 of looking after the interest of, uh, uh, employers and trying to help them get value from their benefit spend. Uh, while I was there, uh, back in, uh, 2011, we did a strategic survey of, uh, companies to see what were the directions that large self-funded corporations, uh, were taking as relating to healthcare benefits. And we found that close to a third of those companies had a healthcare provider coming at the work site, uh, either a few days, a week or longer, uh, to treat the care and the needs of the population.

Larry (02:09):
So we created an organization called the national association of work site health centers, uh, to serve employers interests and needs and sharing of information, and just the ability to, to talk to their peers about this type of healthcare benefit. So now I, uh, serve in the executive director of, uh, the national association work site. Health center is also called NAWHC, N A w H C. Uh, and we have over a hundred companies, uh, large employers, uh, public and private employers, midsize and small. We have union TA Heartly plans and others who offer onsite and site mobile and virtual health centers, uh, for their active employees, their members, spouses, independents, uh, all across the country and all industries and all sizes.

Stan (02:52):
So do you primarily represent the, the providers, the doctors, or the employers that have the providers and doctors?

Larry (03:01):
We, well, we were, the members of the organization are two thirds, are employers, uh, or union to have partly plans, uh, that, uh, contract or offered by themselves, uh, health providers at the work site. So probably about, uh, 25% of these, uh, organizations, actually, uh, physicians and nurses and other staff, uh, build the center themselves and manage it and deal with it. Uh, probably about 40 50% contract out to a third party, uh, service provider or clinic vendor who actually will do a total turnkey operation. And about 20% are run by hospitals, health systems and, uh, local medical groups. And sometimes there’s actually a hybrid mix of those

Stan (03:42):
Are the ones that do it themselves, generally bigger employers and smaller employers higher on the job

Larry (03:48):
Higher, not necessarily, yeah, not necessarily. Uh, what we find is employers who get into this kind of benefit, uh, are doing what I call employer managed healthcare. Uh, and so it doesn’t matter, uh, your size or your industry or your location. It’s really the, the strategic approach, the, the culture of that employer, uh, whether they have a focus on wellness and fitness and productivity and wellbeing, uh, and those companies who are very frustrated with the variability and quality and cost of healthcare in their local communities, tend to be those who step forward, uh, and to, uh, offer this kind of benefit. Uh, so you could have a jumble employer who has, uh, people in every zip code in this country who doesn’t have centers, uh, because they just don’t see the, the need for it, or it’s their not their core business, uh, or their focus more on bottom line costs. Uh, and you can have a very small company that has, uh, 25 people in the small community. Who’s offering a, a nurse and, uh, physical therapist and, and others, uh, at the work site, because they’re really concerned about the health and mental and physical health of their populations, and to make sure that they get good outcomes.

Stan (04:55):
So you mentioned quality and service. What can these direct primary care clinics or, or providers do for example, differently than, than say a, a, a health system clinic, or an independent group of doctors?

Larry (05:12):
So the key thing here is, uh, from an employer’s perspective, how do I keep my people on the job, uh, healthy and productive. And what we find is if people have to leave the work site to, uh, see their doctor to have physical therapy, to pick up a prescription or a medical appliance, they’re gone three to four hours, they go home, they feed the dog, they may not come back to work. Uh, and that when you multiply the average salary of, of employee times, the number of P people who leave work times three to four hours, it’s a significant loss. Uh, in addition, you’ve got people who leave the work site, go to emergency rooms or immediate care centers, which are the highest costs in our healthcare, uh, industry, uh, for non-emergency reasons. So if you can offer health providers who can deliver care to people, uh, at the work site who can address non-emergency situations there, who can keep them on the job or back to work fairly shortly, uh, and give them easy access.

Larry (06:10):
It makes all the difference in the world, uh, for an employer and for employee, you know, people just don’t want to, uh, see dot or get care after hours on weekends at night. Um, it it’s, it takes up their, their, uh, limited, uh, personal time. But if you have a health provider at the work site that you can see within, you know, 15, 20 minutes, or make sure you can get into the next day, it’s important, particularly during the, these COVID times where it’s been so difficult for people to see a primary care doctor, uh, or to get into a, a clinic, uh, having immediate access, which most of these centers offer either same day or next day access is really important.

Stan (06:47):
Larry are the employers who generally do this, are they able to actually quantitate the savings in time, the savings and cost? I mean, is there hard data to support that?

Larry (06:58):
Yes, absolutely. Um, many of the employer, uh, and the third party vendors, whoever provides their centers use electronic medical record systems. Uh, they, these centers typically, uh, can compare what the cost would’ve been in the local community versus those, uh, are offering at the work site. So they’ll use the same C PT codes, for example, for whatever procedures or, or, uh, service or visits there are, uh, and, uh, they can find that, uh, again, reducing the cost of emergency visits, reducing the cost of unnecessary care, um, services. And then again, what people leave, but it it’s a much broader than just a cost issue. Uh, clearly employers wanna reduce their bottom line health spend. Uh, but we, we rather look at what I call a VOI or value on investment approach rather than an ROI or return on capital. So when an employer’s looking to see, you know, what’s, what am I getting out of this?

Larry (07:53):
Is it worthwhile doing, is it worth the investment in the time they look at not just my, my reduce people having to leave work and the cost of that reduce emergency room visit, they’re also looking at increased satisfaction, better outcomes, immediate access to care, higher quality care, uh, more recruitment and retention of employers who find this is most treasured benefit. You know, uh, we, we clearly, uh, learn that this is something that people, uh, enjoy. Uh, they like the quick access to care. They like having a constant provider, uh, and they, and what’s really critical and, and makes for success or not is, uh, the trust and confidentiality they have in these providers to protect their information from an employer, uh, uh, using it for performance evaluation, for example. Uh, so there’s a lot have to go into it.

Stan (08:41):
Does, you know, I have heard some employees where members may be hesitant to go to an clinic that the employer runs because they are fearful about if they talk about drugs or alcohol, it’ll get back to the employer. What kind of safeguards are present?

Larry (08:58):
So typically, uh, and many manufacturers have had, uh, occupational health, uh, for state triage centers in the past, uh, to treat it our work site industry in injuries and accidents. Uh, what we find is that in those cases, uh, the occupational physician or a nurse that’s there, uh, their job, their, their role, and, and under law, they, they are allowed to share the person status with their supervisor, uh, with the employer relating to their ability to return to work, uh, and that’s protected. And so they have that direct communication. And, and when someone goes in to see the occupational health doc, a nurse, uh, they’re pretty well aware that it, uh, their status is gonna be reported. Now you’re right. If in fact, the clinic now decides to offer primary care, chronic disease management, behavioral health services, uh, et cetera, it’s a whole different situation.

Larry (09:50):
And the laws are written as such as that. You cannot share someone’s personal inform information, uh, to their employer, if it does not relate to their work status. Now, the challenges that, uh, this causes is that when an employer already has an occupational health provider there, and now wants to offer primary care, people sometimes are concerned that that provider will also be sharing this personal information. So many employers end up hiring separate providers, or have a separate vendor or a separate clinic for the personal healthcare. So that it’s totally distinct because that issue of, uh, confidentiality and trust, uh, can destroy a center, uh, or if people feel confident about it can actually make it work.

Stan (10:34):
We have an experience. You know, I, one of the companies I consult with was trying to determine whether their direct primary care their, they had a near side clinic was actually valuable for them, and they wanted to how good the care was. We asked the primary care group, this direct primary care group to pointing up some data on how well patients with diabetes were being cared for are using the standard measures. You know, as the industry talks about HEDIS measures, health, evaluat, health, effectiveness, data, and information, uh, statistics, and they were actually able to get population data, not individual person data, but population data on their employees with diabetes Highten asthma, which was something they couldn’t get from their traditional, the, about the employee, the population of the employees that went to, you know, external primary care docs. How, how common is it in the work site, near site world for those providers to actually provide quality data that the employers can use to judge how good the care is?

Larry (11:45):
Well, frankly, that’s a fundamental requirement, uh, in the performance, uh, uh, guarantees and in the contracts of the providers that deliver these types of centers to employers. Uh, as I said, most of them virtually all of them have electronic medical record systems. And so they collect the data and it’s available to them, and they’re able to, uh, actually address a population health strategy approach, you know, in a, an ideal situation. You’ve got the works site center being really the hub of the wheel of all the employers on site, uh, and, uh, benefit programs, wellness programs, pharmacy, uh, chronic disease management, et cetera. So that all the data from all these other vendors filter in to the work site center and the employer then can get a, a total picture of, you know, what’s the prevalence of conditions. We’re where are people going? Where are the costs?

Larry (12:35):
Uh, and you know, the other thing that’s important to remember is that work site centers, the vast, vast majority of them are done on a capitated basis. So there is no fee for service here. There is no direction or motivation or incentive for the providers to do additional units of services that are not needed. Uh, uh, the, the, the visits tend to be 30 to 40 minutes. Uh, it’s a very, uh, holistic kind of care. And then they, when they gather all the data, they can do a soft handoff to other kinds of programs or services. So more, uh, engagement in the, what the employers, uh, programs are. And then they have all this data they can identify and compare and so improve the outcomes of people with chronic conditions, reduce their risk and keep them again at work and productive.

Stan (13:20):
Well, it sounds like that really is a function of a difference in the payment model, not necessarily that their work site or onsite, but they’re not being paid for, you know, the amount of just for the amount of time or the number of clicks on the EMR on the electronic health record. Hey, one of the things I have heard from employers that have direct primary care work site, direct primary care is that sometimes it’s difficult to get spouses and dependence in, and that is especially so when the clinic is actually located on the work site, what are your thoughts about that?

Larry (13:58):
So there’s no doubt that the dependence often are, uh, some of the highest cost, uh, coverage, uh, for an employer’s population. And so one of their objectives and, uh, and, and it’s just not uniformly across all work site centers, but many of them wanna include the dependence, uh, particularly those above 18 utilize the center. So some of the strategies that you need to use, uh, are dependent upon the employer’s location, their space available, and what’s what they wanna do, because if you have the center, uh, in the factory, uh, where it’s, uh, potentially safety issues, security issues, confidentiality issues, you won’t get spouses, you won’t get dependents in there, uh, to so many employers are recognizing, you’ve gotta put this outside of, uh, the, the actual work area. So sometimes in the parking lot, sometimes in a mobile area, uh, but many employers have, uh, created a, a near site strategy.

Larry (14:51):
So it could be one or more centers that are near, uh, the work, as well as near where, uh, people live or in a, a suburban area or, or maybe three or four miles from the work site. In addition, some employers have actually tried to, uh, contract with an say, a hospital system or medical groups or immediate air network. Uh, so that those centers that are open, uh, 24 7 or are open more hours, the work site, uh, people can go to, uh, but clearly there’s a challenge. You’ve gotta offer incentives to get the other people to, to participate. Again, you’ve gotta make sure that, uh, the services are, are accessible for them. And of course they’re be cause, um, 60% of these centers don’t charge anything. There’s no outof pocket cost for people to use the center, to get them services, the drugs, the labs. So there’s a variety of strategy you have to use, but it’s no doubt. It’s an ongoing challenge for people.

Stan (15:45):
You said about 60 would have no co-pay or coinsurance or deductible to see onsite. What would be the benefit for the other 40% to charge if it’s such a good incentive?

Larry (15:57):
Well, some employers believe people have to have skin in the game. Uh, if you don’t, uh, have to pay something, maybe you don’t show up for the visit, uh, and then you’re wasting the provider’s time. Uh, so there’s always gonna be a belief. Now, typically the cost, if there is a cost there’s going to be, uh, much less than it would be. If someone went into local community and under the IRS code, if, if an employer offers health savings accounts, a person with an HSA must pay some mandatory. Co-pay some what they call fair market value fee in order to get access to a center that offers more than just first aid tree. So all those employers, even if they don’t charge anything to anybody else, if people have HSAs, they’ve gotta charge some small co and typically, uh, it’s uh, below, uh, as I said, the community rate, some employers charge as little as $10, some charge just below the Medicare rate provider rate. Uh, but there’s an opportunity to do that, but, uh, it seem to impact utilization very much again, because of the easy access, low cost and comfort that people have with the provider there.

Stan (17:01):
So if they’re not required to have first dollar cover, if, if they’re, if they do have to charge something, you’re saying that that doesn’t make the clinic less successful in terms of, of people accessing it.

Larry (17:16):
That’s correct. Uh, not surprisingly the, the, the key determinant is whether a clinic is successful is the providers who are there now 60% or more of these centers are manned by what they call mid-level providers, nurse practitioners, or physician assistants. Now, there is always a physician oversight, uh, many centers though, have a physician nurse practitioner team, uh, who are there. Uh, so that’s really the, the makeup and, uh, people are comfortable with that

Stan (17:44):
Is the, whether or not the clinic has a physician determined by just the number of people that can potentially access the clinic. What would determine whether you need a doc or not?

Larry (17:55):
Well, frankly, like in many other things in an employer setting, it depends what the CEO wants. If senior management wants a physician nurse, uh, lead team, that’s what’ll happen some of the vendors in the, in the, uh, market, uh, that’s the only kind of model they offer. Uh, but most of the time, as I said, because of cost bases, the mid-level providers are used because they can do so much of what people need in primary care. Uh, and then you can have a physician come in as needed, and many of these centers will have a specialist or a physician, uh, come in, uh, a few times during the week. Anyway,

Stan (18:30):
I work with a few companies that have near side, or actually they have shared near side clinics. And what do I need to tell these companies to do if they don’t feel like they’re getting adequate value?

Larry (18:45):
Well, like in any other health benefit, you’ve gotta see, you know, are your people getting access to the center is when they want to, uh, is the care they’re getting appropriate care? Uh, are, are they getting, are they improved, uh, in their conditions, uh, is the cost comparable, uh, is, uh, the people’s ability to understand, uh, the care they’re getting. Is there follow up? Is there good communication with that? You know, all the things that you’d expect from a primary care, your practice you wanna expect from a near site or onsite center, uh, the experience should be much better, as I said, because the pro the differences is that the providers who work for an employer or in a, an onsite near site center, they understand, or they should be understanding the total benefits that an employer offers. What’s the culture, what are some of the physical, uh, tasks that people have to have?

Larry (19:33):
What’s the kind of role they have? What’s this person going back to, you know, is it a, is it a situation where it’s a very organization that has lots of, uh, languages and culture changes? You know, the, the provider has to be able to practice outside the walls of the center and be part of the employers population rather than a part of a community hospital system or provider network. You know, we’ve got some employers who actually recommend that the employer interview every provider, who’s delivering care at the center to make sure they understand that they’re part of the employer team, that they’re not going to be an issue, uh, because we, we have, uh, centers failing when people don’t like the doctor and then word, uh, passes quickly tie them. Uh, so for example, in one case we’ve had an employer who’s, uh, most people, it was a high tech company, and most of the injuries and issues, uh, happened, uh, on the ball field.

Larry (20:27):
And so they expected that their medical staff would be in t-shirts and shorts on the ball or in the call center or into factory. So it’s, it’s, uh, a different kind of medical practice. A lot of providers really enjoy it, not having to be tied, to fee for service, having really an ability to deliver total holistic care and integrated care. Uh, but some providers are uncomfortable. They don’t, you know, they like to stay within their four walls of the center and they like to practice a certain way and they don’t wanna be bothered. And so that’s why you have some centers successful or not

Stan (21:00):
In terms of determining how well the center is working, you know, surveys and things like that. Should that be the task of the employee, or should the direct primary care be doing that to, you know, to validate their own successful operation?

Larry (21:16):
Well, it, this is always a partnership. Uh, what we find is the most successful centers are those where whomever is delivering the medical services is not just a vendor or provider for the employer, but actually a partner. So they work together to identify how are they gonna collect this kind of information? Are they gonna do joint surveys, or at least they’re gonna spell out what kind of surveys will be done. Typically the provider will do most of those surveys, uh, will collect that data, but the employer itself might wanna do it. Uh, you know, many times people will talk to a provider other than to their employer about, excuse me, these kinds of benefits and things. And so, uh, you know, I think it’s something they both have to work on, but they both need information. You wanna find out, you know, are people able to get in when they want to, are they satisfied, uh, with the care, do they feel they’re getting respect, uh, with the providers?

Larry (22:06):
Um, are they able to get a follow up and from a, uh, uh, are they getting better? Uh, if they have a question, can they get back to that? So all the, the same kind of things that are in the, uh, the cap surveys, uh, that are being used, or even in the, uh, uh, the hospital surveys, uh, that are, are done on satisfaction, similar, those things should be tied in, but in many cases, you’re looking at the registration process, uh, the ability to get, to see the providers the follow up, um, and the understanding and care provided.

Stan (22:38):
So you talked about a collaboration between the employer and the clinic. How often should they get together? Should it be in person and at, you know, should the reports be going back to the C level to human resources? Tell us, tell us what the most successful collaborations are.

Larry (22:56):
So the ones that are most successful, uh, have multiple levels of reporting, uh, there’s weekly reporting on utilization and any issues or operational, uh, concerns. There’s monthly reporting on the number of people being used, uh, whether you’re filling appointments, uh, how the systems are going, uh, whether you you’re having, uh, any challenges, uh, quarterly and annual reports. And again, it’s gotta cover all the things I mentioned. That’s relating to values, gotta look at, uh, delivery of care, quality of care, satisfaction, uh, people’s responsiveness participation in programs, engagement in programs, uh, costs, uh, you know, are, what are people doing are how many people are in the hospital? Are people with high risk conditions getting lower risks, or are they getting worse? Uh, what are, and then overall, what it’s generic scores or how people who are on, uh, statins, are they getting better? Uh, what’s the, the total picture of care has to be reviewed between those delivering to care and the employer, uh, to see if the employer’s objectives are really being reached.

Larry (23:57):
And if people are being said, if you’ve got a center whose utilization is increasingly, uh, high, uh, you’re gonna, you, you are wanna be checking that, but if you find people are not going, or they’re not going certain hours, you wanna know the other key thing you wanna find out is you start out with a basic scope of services. What do you wanna expand to you find that people, for example, maybe they’re leaving work for physical therapy. So you wanna bring physical therapy on site. Maybe they’re leaving work to see a chiropractor. So maybe you wanna bring a chiropractor on site, whatever the case might be. If you’ve got a fitness center, can you expand that? So a key part of the analysis of the results of value of the center is where other, what other services can we offer that people will take advantage of?

Larry (24:39):
Or where are people leaving the work site for things we could do? Should we have a nutritionist on site? Do we need the health? Do we need a cancer navigator? You know, what kind of things can we do? And in many cases, it’s forming partnerships with local health providers or health systems or other organizations that can supplement what they have, or in some cases, maybe they’re doing a lot of imaging. And they’re finding that the cost of using, uh, the hospital imaging center is too high. So they partner and on the employer look for local imaging centers that they can contract with or laboratories or physical therapy. So there’s lots of things you can look at, but if you’re not constantly monitoring and measuring, you’re never gonna know what happens. Then just a sidebar. One of the frustrations I’ve always had in my career in working with employers is it didn’t matter whether it was a smoking cessation diabetes program, uh, arthritis, 25% of employers never measured the results of the program. They never knew whether it was working or not, or getting value or what people thought. And it was just throwing money out the door. And so in, in my life and work, now, we constantly emphasize, you know, with no, no, without measurement, there’s no way of knowing whether your, uh, thing is working or not. You’ve gotta take time.

Stan (25:51):
Y you mentioned wellness. I know there are some DPC providers that kind of had an a, that that offer add-on programs for wellness, you know, that have biometric screening and personal health assessments. What’s your thought about that? Or should they stay in the single SW and

Larry (26:09):
No, I, I mean, I, I think you, uh, when you’re offering these kinds of services, uh, you wanna expand the scope for whatever the needs are of that population. Uh, and if someone, as I said, has cancer and needs the guidance and direction. I, if you can link them with a cancer navigator or advocate, someone who can get them through the, of all the things you’ve gotta decide, and the different providers who are out there and what’s gonna happen with their benefits and their job and their life, uh, it’s gonna be incredibly helpful. Uh, we found that, uh, for example, muscu pain management was a, one of the top three issues for most of the employers, but many of ’em did not offer, uh, the kind of, uh, support that they needed. People again were going offsite. So now we’re saying more and more what I we’ll call physical health integrated teams. So you have a physician of physical therapist, a chiropractor, acupuncturist, massage therapists, working together as a total team, not as independent practitioner, uh, but working together reduces the need for opioids and other, uh, medications and keeps people, uh, the ability to, again, stay at work, get the care they need often early on, and not just after they have an injury.

Stan (27:17):
You, um, what if an employer decides, you know, I need to explore this, what do they do? What’s the, what’s their next step contact local.

Larry (27:31):
Yeah. I mean, they

Stan (27:32):
Contact a local provider.

Larry (27:34):
Uh, you know, the first thing they need to do is to look at their data. I mean, you can’t get into a program like this, which can be very expensive. And, uh, unless you, I understand there’s gonna be a real need. So some of the things you need to do is, uh, if you have a broker consultant, whoever has your data look at that, determine, you know, where, how many people are leaving work to go to emergency rooms, to get care, immediate care centers, uh, who are not getting access to the providers. They need, what’s the prevalence of our conditions. You know, if we’ve got an average age of 23, we’re gonna have certain kinds of services we want compared to, we have an average age of 48, uh, or 50. Um, so once you get an idea of what kind of conditions you have, uh, and where the cost and where people are going, but then you really have to ask the population through surveys, focus groups.

Larry (28:22):
You know, if you offer services at the works, I will, people come, uh, will spouses come if, uh, if you offer these things, will people take the time? Uh, and, and what kind of structure in your work Heights policy will you do? Will you let people come during the work hours or after work, are you gonna charge or not charge? What are your objectives? And then once you figure out what your objectives, you know, you wanna offer easy access or no cost. You want people to be productive. You wanna offer a certain core of, uh, uh, primary care services. Then you go and you ask your consultant broker in the marketplace, you know, who’s the local providers, what, who’s the third party vendors, or frankly, one of the things that, that I think most employers like to do, they look at their peer companies who else in the community, or in my industry, or who I benchmark against has a, a non site or near site or shared center.

Larry (29:11):
And can I visit them? And I can, can I learn how it works? Can I talk to the people who work there? Can I talk to the people who go there, um, and determine, are they saving money? Are they, are they meeting their objectives? Are they keeping people productive as quality better? Um, and then what’s this vendor like, and then look at the options that are out there. Should you want to do it yourself, or do you want to hire somebody else to do it? Do you wanna provider health system? Um, in many cases, uh, maybe many is too strong, a word, a number of cases. Uh, the employers don’t feel the local health system or medical groups are meeting their needs in the community. They don’t like the quality respons. So they go to a third party vendor to bring in providers. Um, but you need to give yourself the option of looking at all of those and then do some comparisons, and then you’ll get, and then of course in the RFPs you wanna put down, what are the performance levels you’re looking for to make sure that you don’t wait until you selected someone to see if they can perform the right way.

Larry (30:10):
So, to me, those are the, the major steps you take.

Stan (30:14):
Is there a place that a lawyer can get kind of a, an RFI template if they wish to do that?

Larry (30:20):
Sure. So, uh, w H C has a, a plethora of information in the clearinghouse of data, uh, for organizations who wanna learn how to offer this kind of benefit, uh, what other employers are doing, uh, what are the kinds of services and staff and who the vendors are in the community? Uh, clearly we do this primarily for those who join as members. Uh, but if someone would just want to call, visit the website, uh, they can get a lot of information. We’d be glad to start ’em out the right place.

Stan (30:48):
So, final question, you talked about near site clinics. How near does the near site clinic need to be, to be effective?

Larry (30:57):
Uh, it depends on the geography, uh, and the, the employers location and what they have. A lot of employers don’t get into this, cuz they don’t have the space for it. Uh, so they’ll look someplace nearby. It could be across the street, it could be a mile away. Uh, you know, if you have a large population of over 500 employees in one location, typically an onsite would make more sense. Uh, but for near site it could be, uh, like a media care, a care centers in the community. Uh, they could be several miles away just so people can reach them, but you wanna have a, a location that people can get to and get back, uh, within a fairly short time. I mean, when I used to live in Chicago, people just going from downtown to the suburban area could be gone to three hours.

Larry (31:40):
Uh, so it depends on your geographic community into travel idea. You want the near site within a mile of the location of the workforce. Uh, but again, if you wanna have a network of near sites, uh, that allow people from different locations, that would be helpful. In addition, there’s some vendors and some, uh, communities where they’ve created, uh, uh, a common vendor at, but near sites all around and different employers. So the employee or their family, regardless of where they live can go to any employer’s site because it’s the same vendor and they still are able to share that information back to the core place.

Stan (32:13):
Great. Hey, Larry, one last one, one more last, last question. What would be the most important success factor? The most important factor to predict the at installing director or near side of work side clinic will be successful.

Larry (32:31):
It’s all about utilization. Uh, you know, if you, if you get 60, 70% of people utilizing it, or ideally that at 18 to 20% of people who have chronic disease who cause 85, 9 to 90% of your cost utilizing center, it is successful. If you’ve got a utilization of, uh, 10, 20%, uh, you’re not gonna be, uh, having that center very long.

Stan (32:54):
Great. Larry, if people wanna contact your organization, can you tell us what the website is?

Larry (33:00):
Sure. Anybody can go to www a w hc.org, uh, or they can call me directly at (847) 606-5527. And my email is LBOR ESS@NAWHC.org. Thanks so much for the time.

Stan (33:17):
Thank you for joining us. Our guest today has been Larry Boress. Who’s the executive director of ed, a NWA eight. I’ll never get that

Stan (33:30):
NAWHC.org. And thank you very much for your insight. This episode today has been brought to you by zero studios from our sponsor zero.health, also on the web by thanks very much. And for our listeners, we’ll see you next month.

Narrator (33:45):
We hope you’ve enjoyed the time with our very own doctor Stan for 360 degrees of healthcare with Dr. Stan Schwartz, a part of zero studios tune in subscribe and review our podcast to keep current with the ins and outs of the medical and healthcare industry from the inside out.

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