In an effort to contain rising employee healthcare costs and attract and retain talent, more and more corporations are opening up healthcare clinics right inside their office buildings.

While the concept of on-site healthcare has been around for some time, with many companies providing first aid and urgent care to treat worksite injuries in their production plants and warehouses, the on-site concept has shifted toward a broader corporate wellness strategy, says Josh Golumb, president of healthcare services company Paladina Health (San Francisco), which helps companies set up on-site clinics.

In fact, a 2013 National Business Group on Health survey found that 44 percent of employers (those with more than 5,000 employees) currently have on-site clinics and 9 percent are considering them. According to the same survey, 67 percent cite employees’ poor health habits as the single greatest challenge to managing healthcare costs, thereby creating a strong need to broaden engagement and proactive strategies.

Additionally, a 2012 survey of employers who have built or plan to build on-site clinics, conducted by the New-York based global professional services company Towers Watson, revealed that 62 percent of companies build on-site clinics to enhance worker productivity, 57 percent to reduce medical costs, 48 to create a center of health to better integrate health productivity efforts, and 46 to improve access to care.

“Studies have found that a typical day doesn’t include time to see a physician, and therefore, a majority of employees choose to postpone preventive care,” says Lisa Marie Gorman, director of the St. Joseph Health Wellness Center Park Place (Irvine, Calif.), which delivers on-site healthcare to 8,000 St. Joseph employees. “We’ve found that creating a super-convenient yet private space can make the difference, saving two or more hours of work time, and reducing absenteeism while increasing productivity,” she says.

Scott Shreeve, CEO of Crossover Health (Aliso Viejo, Calif.), which specializes in planning and designing worksite primary care clinics, says he’s seen popularity grow as corporations are starting to view these amenities as being on par with cafeterias and fitness centers.

However, the catchment area is much larger than simply corporate America, notes A. Michael La Penna, a healthcare business consultant and author of Workplace Clinics and Employer Managed Healthcare: A Catalyst for Cost Savings and Improved Productivity (Grand Rapids, Mich.). “The self-funded employer community includes municipalities, school districts, colleges, and a variety of other entities,” he says.

Well-laid plans
Once the decision has been made to build an on-site clinic, planning begins with an analysis of a company’s medical claims history, a utilization estimate based on an assessment of local access to medical care, the company’s benefit programming, and the nature of the services to be provided on-site, La Penna says.

Crossover, for example, has developed an algorithm to help clients determine how much space to allocate. “In partnership with our clients, we determine the scope of desired service, eligible population, growth rate of the population, and days/hours of operation, to project utilization by service type and, ultimately, [determine] the required facility size,” says David Lees, vice president of client services for Crossover. The algorithm also provides a room count, equipment list, staffing model, and budget for the project, which is built to five-year utilization projections.

Ultimately, these spaces will range in size from 500 square feet to 5,000 square feet, with a separate entrance and exit to ensure privacy and provide access to employee dependents, if applicable.

Offering more specific guidelines, Ford Brewer, chief medical officer for worksite healthcare provider CHS/Take Care (Reston, Va.), explains that clinics with one caregiver generally require 1,200 to 1,500 square feet, with two providers requiring 1,700 to 2,000 square feet and three providers requiring 3,000 to 3,600 square feet. McNamara adds that exam/treatment room should be no smaller than 130 square feet.

With an eye on growth over time, CHS/Take Care also incorporates multipurpose and modular spaces; accommodations for cyclical services, such as flu shots; and flexible workspaces that aren’t specific to a type of service provided.

Depending on an organization’s resources, clinics can either be built from the ground up or retrofitted within an existing space. “We’ve retrofitted conference rooms into mini-clinics,” Golumb says. “Companies with large corporate campuses or warehouse buildings may have moveable wall space that can serve well as a retrofitted clinic, which ends up being a cost savings in the long run.”

In terms of addressing confidentiality and employee privacy, McNamara recommends frosting visible windows and separating exam rooms by walls, not curtains, to ensure HIPAA compliance. Meanwhile, ADA-compliant bathrooms should be located near the entrance to support easy access for testing.

“Companies also need to consider logistics to accommodate vendors. For example, hazardous waste pickup must have access to designated waste, and lab services must access the specimen lockbox,” McNamara adds.

Security is another planning issue, especially when employees’ dependents are serviced by the on-site clinic. Parking and an outside entrance should be provided; however, the clinic needs to be designed to prevent nonemployees from gaining access to the office building itself. In some cases, Golumb says, it may be preferable to position the clinic as a separate structure within easily accessed real estate—for example, inside strip malls or medical office space in the neighborhood.

The fit-out
When selecting materials and interiors for on-site clinics, company culture and industry are key design drivers. “For example, basic yet comfortable design is more appropriate in a factory or industrial setting, or where the clinic is funded by taxpayer dollars,” Golumb says. “For on-site clinics in corporate office settings or ‘near-site’ clinics located in retail locations in central business districts, higher-end décor may be more appropriate.”

For the former, clinics might be designed with unfinished concrete floors, exposed ceilings, or the application of plywood and corrugated steel as building materials. As for the latter, the aim is often Class A medical space. As such, easy-to-clean surfaces and upholstery might be specified with either commercial carpet tile to evoke warmth and texture or vinyl floor planks or ceramic tile with the look and feel of hardwood, says Chris Hickman, assistant vice president of Petra Integrated Construction Strategies (Culver City, Calif.).

“Creating a concierge spa-like environment encourages employees to use the clinic. It becomes an oasis in their busy day where they can relax while receiving medical care and health education,” Hickman says. “Other elements include aromatherapy to eliminate the medicinal smell of a medical office, flavored water in the lounge, full spectrum lighting, and the use of colors and textures to induce a sense of peace and well-being.”

To get the details righ
t, Crossover often builds mock-ups of key rooms, such as the exam room. For one particular project, Crossover went through nearly a dozen iterations to fine-tune the layout. “Having ‘lived’ in the space for about a year now, there is very little we would change,” Lees says. “The cubic feet of cabinet space is just right, there are no lights directly over the exam table, electric cords are hidden, there is a generous closet with a USB charger for electronic gear, a functional consultation area has been worked in, the casework is designed to open in the back for trash and soiled linen removal, and the diagnostics panel has been recessed into the wall.”

The right prescription
As healthcare costs progressively escalate while companies compete for the best and brightest, on-site clinics are expected to continue gaining traction as a comprehensive solution to multiple issues, which all organizations struggle with.

“With growing demand for worksite health clinics, the industry is in the sweet spot for where healthcare is going in the United States,” Shreeve says.


SIDEBAR: Beyond the basics

Going above and beyond, some progressive companies are providing more than just on-site primary healthcare to their employees to include amenities such as “health bars” and Zen lounges, too.

On-site healthcare specialist Crossover Health often incorporates health bars into the worksite clinics it designs. “Positioned in a quiet corner in our welcome area, the health bar is a place where employees can go to get advice on a wide range of health issues,” says David Lees, vice president of client services for Crossover Health. “Various subject matter experts have set hours for employees to visit. These ‘health baristas’ range from dietitians to fitness trainers to benefits experts to lifestyle coaches.”

In addition, Crossover’s Zen Lounge is a small, meditative space that can be connected to a massage and acupuncture suite of rooms. “It’s a relaxing space with a water feature, soft lighting, and infused water where a patient can meditate quietly while waiting for treatment or post-care.”

In a similar vein, another firm specializing in on-site healthcare facilities designs these spaces to accommodate more than just flu shots and throat cultures.

“Our clinics also accommodate wellness programs and services, including lifestyle management, weight management, stress management, and health coaching,” says Chris Hickman, assistant vice president of Petra Integrated Construction Strategies. “Ideally, there’s a conference/class room that can be used for group exercise such as yoga, cooking demonstrations, and lunch-and-learns.”