On Wednesday mornings, Stephen Fealy, an orthopedic surgeon in New York, heads downtown to see his patients. But instead of going to his office, Dr. Fealy sees patients in theirs—at Goldman Sachs Group Inc.
He examines a couple of dozen Goldman employees, from managing directors to junior analysts and administrative assistants.
Dr. Fealy, a sports-medicine specialist with the Hospital for Special Surgery in New York, works alongside several other physicians at the Goldman Sachs clinic on the 10th floor of the firm’s headquarters, near Wall Street.
Getting out of his hospital digs makes Dr. Fealy feel a bit like doctors of old who made house calls. Now, when employees all but live at the office, it makes sense to see them there.
“These people work incredibly hard, they come in with back pain, hip pain,” he says of his Goldman patients. Dr. Fealy treats cases of what he calls “investment-banker neck,” an arthritis that can afflict people in their late 40s, particularly ones peering at lots of monitors.
Employers hoping to keep workers healthy and productive are moving beyond yoga workshops and webinars on work-life balance. More and more businesses are establishing on-site medical clinics, where employees can receive primary care and in some cases consult with specialists—all without venturing far from work.
Many companies view the clinics as a means to deal with crushing health-care costs while making sure employees get adequate care and attention. Others, in Silicon Valley and elsewhere, consider them an essential hiring and retention tool. Some clinics boast that they offer a better experience than traditional doctor visits, because they don’t make patients wait or rush physicians through consultations.
At Goldman Sachs in New York, staff can access an emergency physician any weekday and see rotating primary-care physicians and specialists including a dermatologist and a gynecologist, as well as Dr. Fealy, the orthopedic surgeon. There are physical therapists on hand as well as a visiting physiatrist, a specialist in rehabilitation medicine.
Premise Health, located in the Nashville, Tenn., suburb of Brentwood, oversees Goldman’s center. The firm, like the rest of the industry, has grown swiftly in recent years, according to Chief Executive Stuart Clark. “An on-site health center used to be a nice-to-have novelty,” he says, “but it is now considered a mainstream benefit for a large employer.”
In competitive labor markets, an on-site clinic can mean an edge in recruiting says
who heads the National Association of Worksite Health Centers, a trade association founded in 2012. “If you go to Silicon Valley, [companies] are tremendously competitive with their on-site centers because people can go anywhere, and they will ask, ‘Do you have an acupuncturist? [Do you have] a chiropractor?,’ ” Mr. Boress says.
A 2014 study by his organization estimated that 30% of American businesses of all sizes had on-site medical care for employees. By 2018, around 50% will offer the service, Mr. Boress says, citing a more recent industry study which found that an additional 11% of firms were considering establishing clinics by 2020. The level of care varies, he says, from a single nurse to a team of primary-care physicians and specialists.
Premise is one of the nation’s largest managers of on-site health clinics, according to the firm’s CEO, Mr. Clark. The company was founded in 2014, with the merger of two companies, one dating back to the 1970s. The industry has evolved from decades ago, he says, when health care at work often consisted of a company nurse who dispensed aspirin.
Many clinics are located within a company’s premises or campus. Others are nearby and serve employees as well as their families. In this month alone, Premise will oversee the opening of 33 health centers offering various levels of service, most centered around primary care. Five years ago, the companies that went on to comprise Premise presided over a similar number of openings during an entire year, Mr. Clark says.
On-site clinics have become more elaborate. In 2016, Cummins Inc., a maker of engines, generators and related products, opened the Cummins LiveWell Center, a 28,000-square-foot health center on its main campus in Columbus, Ind. At LiveWell, employees can meet with primary-care physicians, an optometrist, a gynecologist, and a physician’s assistant who specializes in dermatology. The center, which is decorated with paintings and other art, has life coaches and a room for massage therapy. A chef comes in to demonstrate how to cook “plant-based” vegan meals.
LiveWell tries “to go a little beyond traditional American [health] care,” says
a senior spokesman.
On-site clinics are flourishing because employers are increasingly desperate, says Mr. Clark of Premise Health. “Health-care costs are totally out of control in this country at the same time the population is getting sicker.”
When employees see a primary-care doctor at one of Premise’s on-site health centers, they typically don’t pay more than a nominal fee, if that. An on-site health center “is in addition to, not instead of” a traditional health insurance plan, Mr. Clark emphasizes. Employees invariably are covered by health insurance and can go to outside physicians anytime they wish. In cases where people have high-deductible plans, they pay more to go to the on-site center.
The centers that Premise operates can cost anywhere from $250,000 to $20 million or more annually, Mr. Clark said, citing one client company with 40,000 employees. Premise hires the physicians and pays them a salary. These clinics “have to save more money than they cost,” he says, with the host company seeing lower insurance costs and better health outcomes.
At Goldman Sachs, patients pay doctors and specialists at the on-site clinics through their insurance plan, just as if consulting with them privately; typically, that means a copayment. That tends to be the case in the New York market, Mr. Clark says. In other health centers around the country that Premise runs, he hires specialists to come in certain days a week, so employees don’t pay much or use their insurance even to consult with a cardiologist or dermatologist.
‘People can go anywhere, and they will ask: Do you have an acupuncturist? [Do you have] a chiropractor?’
Cisco Systems Inc., of San Jose, Calif., offers both an acupuncturist and a chiropractor, along with primary-care physicians and pediatricians, says Katelyn Johnson, a senior integrated health manager at the technology company. Ms. Johnson oversees the on-site clinics known as LifeConnections at Cisco’s Silicon Valley headquarters along with ones at Cisco facilities in North Carolina’s Research Triangle Park and India.
“We are combining Western with Eastern [medicine],” Ms. Johnson says. That means access to doctors connected with Stanford Health Care as well as alternative-medicine specialists.
Cisco has been working directly with the Stanford health system to operate the on-site clinic. Ms. Johnson says LifeConnections pledges no waiting time for employees or for their children consulting a pediatrician. “Physicians have slots for same-day service,” she says. “We make sure you get in.”
John Jackson, who oversees Stanford’s Corporate Health Programs, says his division has been expanding as the health system forms more relationships directly with employers. Stanford can compete with firms operating on-site clinics, he says, by coordinating between primary-care doctors and its own specialists on complex cases.
Mr. Clark of Premise Health says some on-site health centers, such as the one at Cummins, don’t even have waiting rooms. He believes the clinics save time by eliminating paperwork and administrative tasks that burden most doctors’ offices. In his contracts with various companies, Mr. Clark says, performance guarantees sometimes stipulate waits of less than five minutes. Employees walk in or make appointments with an app or a phone call. Doctors usually allot a generous 30 minutes per patient.
Mr. Clark also said any privacy concerns that some might have about on-site clinics were unfounded. He cited the tough Health Insurance Portability and Accountability law that regulates sharing health information. “It is the law of the land, and we are not going to break it,” Mr. Clark says.
Arthur Caplan, a bioethicist who oversees the division of medical ethics at the NYU School of Medicine, agrees that health information is protected: “When your employer pays for a boutique health center, they cannot see your personal health information.” Still, he adds, there are risks. “But they do know general information which may hurt you, if the number of employees is small. The employer will know if there is a surge, say, in the percentage of workers who are seeking help with anxiety or drug addiction.”
Over the years, Kane Brenan, a managing director at Goldman Sachs, has dealt with a number of ailments. “I have had knee surgery, a sprained ankle, I have had a bad back [and] hip,” he says and being able to see Dr. Fealy, his orthopedic surgeon, and other doctors at the office is a big plus. Having physical therapists close by also makes it easier to stick to his twice-a-week treatment regimen.
“It is remarkably convenient,” Mr. Brenan says, “rather than a four-hour round trip to get somewhere, you take the elevator down, you have a 45-minute session, and you are back at your desk.”
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