On-Site Doctors Bolster Disease Management

Doctors in medical clinics at employer work sites are three times more likely to get employees with chronic illnesses enrolled in disease management programs than the telephone counselors most programs rely on, a new study shows.

The findings, published last week in the Journal of Disease Management, give added weight to the growing interest by large employers in having primary care clinics in the workplace.

The study was conducted by CHD Meridian Healthcare, based in Chadds Ford, Pennsylvania, at a health clinic the company operates at a Goodyear Tire & Rubber Co. plant in Gadsden, Alabama. CHD Meridian identified 1,815 employees with diabetes, hypertension or coronary heart disease as being potential participants in a disease management pro- gram. Seventy-six percent of eligible patients who were encouraged during meetings with their doctor at work-site clinics enrolled in the disease management program, compared with an industry average of around 25 percent, says Raymond Fabius, president and chief medical officer of CHD Meridian Health­care and one of the study’s authors.

“Traditional disease management programs have depended on anonymous, albeit very well-meaning, nurse case managers making telephone calls to patients, often independent of their trusted clinicians,” Fabius says. “Our key finding showed the remarkable power that a trusted primary care clinician has on effecting behavior change.”

Employers have taken a renewed interest in disease management programs in hopes that by detecting and managing chronic illnesses they will improve the health of their employees and reduce long-term medical costs. Disease management companies use computer modeling programs and health risk assessments to identify at-risk patients. Most rely on over-the-phone counseling to enroll patients.

The study suggests that doctors at work-site clinics do a better job.

“When you place the trusted clinician in the workplace and you capture the majority of the covered population, it’s much easier to drive a wellness or disease management program because you [the employer] are only dealing with one doctor’s office,” Fabius says.

Doctors who are spread throughout the community often must divide their time among different patient populations, health insurance companies and various disease management programs.

Another issue is economics. Insurance companies pay doctors a fixed rate for each patient visit, regardless of whether the visit lasts five minutes or 50. Face-to-face counseling, often the most important way to change patient behavior, is the first thing to be sacrificed, doctors say.

But not every employer needs to build a work-site clinic to get those results, says Dexter Shurney, chief medical officer for Healthways, a disease management company based in Nashville, Tennessee. Shurney says Healthways enrolls 90 percent of eligible patients into disease management programs through its telephone counseling services.

“A number of models can work as long as you establish that level of trust,” Shur­ney says. “Companies need to think about leveraging the kinds of things they already have in place” before investing in a work-site clinic.

Fabius estimates a company would need 1,500 employees at one work site to support one physician’s practice.

—Jeremy Smerd