As I See It: ITCare

If you’re a mouse but aspire to grow into something as large as an elephant, evolution may oblige you, but it will take about 24 million generations–give or take a mass extinction. But there are faster ways. You could become a government program. Conceived through the biological mastery uniquely resident in the U.S. Congress, a mouse built to government specifications instantly becomes an elephant. Just add money.

Thus we have the grotesque specter of Obamacare. All 1,990 pages of it. Neither fish nor fowl, it crawled out of the primordial ooze of the healthcare lobby, a fully formed pachyderm. But in Washington, it’s important not to call things by their right name, so what is clearly an Insurance Company Enrichment Act is masquerading as something called the Affordable Care Act.

Makes you long for a Congressional mass extinction.

The need to reign in healthcare costs has long been an urgent issue for employers and employees alike. Many companies have been forced to scale back their medical coverage even though few things can bring down working families faster than a major healthcare crisis. Of the people who file for bankruptcy citing medical reasons, the majority actually had insurance. And while any movement toward universal access must be applauded, waiting for the government to fix the healthcare system is like Waiting for Godot– never comes.

There is, however, a painless remedy available to IT professionals. Progressive companies like Hewlett-Packard, Cisco Systems, Facebook, Apple, and Google are offering in-house healthcare to their employees. And here’s the surprise: while the care is mostly free, the companies still save money.

Providing some measure of healthcare in the workplace is not a new concept, although in Silicon Valley and elsewhere the model is being modernized and expanded. According to Ranjini Raghunath writing for the Palo Alto Weekly, “as far back as the 1930s, Kaiser created healthcare centers for the railroad camps on the West Coast.” Likewise, most manufacturing enterprises and resource-extracting industries, whose workers labored under dangerous conditions far from medical help, also offered rudimentary care.

More recently, companies began sponsoring holistic “wellness programs” designed to assist employees with such issues as stress management, weight loss, smoking cessation, and proper nutrition. Many companies built gyms and fitness centers. But actual medical interventions were rare. Cost, liability, and the absence of trained medical personnel kept the programs focused more on prevention and lifestyle, than treatment.

But in the last 30 years, medical costs have exploded. In 2008, GM reported having to add $1,525 per vehicle just to cover its medical costs. It was spending an astonishing $71 per hour per employee on healthcare, well over $5 billion a year–more than the cost of its steel purchases. Clearly something had to be done.

That “something” was bringing the full range of healthcare services in-house. Some companies hired physicians and staff, others farmed out the function to companies that specialize in workplace health systems. But the benefits were identical. Drop-in clinics allowed patients to be seen almost immediately, eliminating both driving time and the obligatory sitting-in-the-sterile-examination-room-hoping-somebody-remembers-you’re-there. And the hours not spent traveling to and from medical appointments, were hours spent working.

Today, says Raghunath, “an employee can walk into an on-site health center for flu shots, blood tests, vaccinations, physical therapy, acupuncture or chronic disease management. Some centers also have radiology labs, vision care, dental services and a pharmacy on-site. . . .”

The clinic in the Facebook complex allows employees to check in on an iPad and write suggestions and comments on the wall. Facebook’s director of Global Benefits, Nina McQueen, told Raghunath, “We do everything from primary care to women’s health, travel care, flu shots, physicals, allergy shots, occupational health, breast cancer awareness, mindfulness seminars, and skin cancer screening.” The company has been so pleased with its results, writes Raghunath, that it hopes to extend the program to employee’s families.

Onsite clinics are particularly useful to companies with a mobile workforce. Employees who transfer from distant cities (or countries), can obtain medical care without having to search for a local physician. Language becomes less of a barrier. Doctor visits become less threatening.

Often employees will avoid seeing a physician until they are seriously ill. Not wanting to miss work, most people soldier on until they simply can’t, which usually results in prolonged absenteeism. In-house care has a preemptive advantage. Serious maladies such as diabetes, hypertension, obesity, and heart disease–if diagnosed and treated early–can be reversed. A precautionary visit can save employees from the acute consequences of delay, and the employer from the bills that accompany it. Companies offering in-house care report that employee visits to the emergency room–the most costly healthcare option–have been dramatically reduced by up to 30 percent.

Additional savings are possible because in-house clinics do not charge a Shylockian markup. ABC News reported that a North Carolina-based company, HanesBrands, saved $140 for every dollar it spent on in-house care. And it achieved those savings “despite the fact that the clinic is free.” While such savings are uncommon, a 3-1 return on investment is not. Which is why, as ABC reports, “In 2011, 23 percent of [over 1,000] companies surveyed said they had an onsite medical clinic; in 2012, 28 percent; in 2013 that rose to 32 percent.” And 39 percent say they will provide onsite medical care in the coming year.

For corporations, greater liability is the tradeoff for savings. For employees, fear that their personal medical information may become known to their employer is the tradeoff for convenience. Liability can be minimized by contracting with third-party vendors whose computer systems run independently. But given repeated evidence that personal data is never fully secure, concerned employees may choose to be selective about the type of care they seek.

Scalability may also be a consideration. Cisco and Apple, for example, hired companies with the capacity not only to operate clinics in Silicon Valley, but to provide nationwide and even international service. By all accounts the model is successful and spreading, with the infectious dexterity of a virus.

Certainly, in-house clinics are not the decisive solution to the tangled mess that is healthcare. But they are imaginative, timely, and represent a huge step forward out of the morass of the problem state, into the realm of solutions.

And, miraculously, in-house clinics appear to strike a compromise that has steadily eluded the 535 geniuses in Congress. Republicans will like them because they are market driven and allow corporations to have fewer expenses, which is good for investors. Democrats will like them because they provide equal access and low cost or free healthcare to every employee. Independents will like them because they, like the rest of us, have not read the 1,990 pages of the Affordable Care Act, and have no hope of ever understanding it, or navigating successfully through its Byzantine provisions.

ITCare, sign up at an employer near you.

                     Post this story to del.icio.us
               Post this story to Digg
    Post this story to Slashdot