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Worksite Health Services 2019
Measuring Clinic Adoption and Outcomes
Author
Joe VanDeGraaff
Author
Alex McIntosh
As healthcare costs continue to climb, employers are attempting to mitigate the impact by taking measures to help manage and improve the health of their employees. A very tangible step—particularly common among self-insured employers—is to engage a worksite health services firm to provide employees (and sometimes their dependents) with primary care and related services. Employers generally agree that employees view workplace clinics as a nice benefit, but the real question is whether the clinics actually improve employee health and reduce costs. This KLAS report is intended to increase transparency in the market by shining a light on employers’ real-world experiences with various worksite health services firms.
When deploying a worksite health services strategy, employer organizations typically take one of three approaches (outlined below). This report focuses on the first.
Approach 1
Engage/contract with a dedicated third-party firm for worksite clinics and health services.
Approach 2
Adopt a do-it-yourself approach in which the employer organization resources their own clinical staff and provides health services to their employees on their own.
Approach 3
Adopt a hybrid approach in which the employer organization contracts with a firm for some worksite health services but also provides some worksite health services on their own.
(Note: Instead of contracting with a traditional dedicated third-party firm, some employer organizations may contract with a local hospital or health plan for worksite health services).
Report Focus and Content
To understand the client experience and what value worksite health services provide, KLAS conducted in-depth interviews with 178 employer organizations that currently engage a worksite health services firm. Anonymized customer experience ratings, commentary, and satisfaction data from these employers make up the core of this report’s content, which is divided into three overall sections of context and insight. KLAS encourages employers to consider these factors when selecting a worksite health services firm for the first time or replacing an existing firm.
Basic Scoping Alignment
Fundamental scoping questions that KLAS recommends all employers carefully explore to determine how well each firm’s offering aligns with their own needs.
Value and Performance Data
Nearly all employers expect their firm to not just provide good service but also deliver value and outcomes. Findings in this section are based on KLAS performance data, as reported by current employer clients.
Firm-Provided Information
To provide additional context beyond KLAS performance data, we invited firms to share their perspectives on select topics that are important to employers and the industry today.
BASIC SCOPING ALIGNMENT
Most firms in this market, save those who may be relatively new or just starting out, offer a broad set of services (see chart below) and report having clients in multiple verticals. Where firms tend to be more differentiated is in the size of their active customer base and in their geographical coverage, i.e., what states they operate in and how national their presence is. High-level insights into these factors are covered in the next section in context with actual client-reported performance and outcomes.
VALUE AND PERFORMANCE DATA
Firm Transparency/Collaboration
KLAS’ mission is to improve the world’s healthcare by measuring and reporting on the performance of vendors’ healthcare technology and services. Wherever possible, KLAS seeks to measure the vendors that are most relevant in their respective markets, regardless of a vendor’s level of participation or engagement with KLAS.
KLAS’ ability to measure customer satisfaction relies partly on vendor collaboration. This is especially true in markets such as worksite health services, which represents a new area of research for KLAS. Given the early status of this research, it is important to recognize the firms that have shown early courage and taken steps to embrace third-party measurement of their customers’ experience. With the aim of helping the industry improve and enabling employers to see independent performance measurement and benchmarks on all major firms, it is likewise important to note the firms whose transparency and collaboration could be much greater. While this report includes a healthy representation of the major services firms in this market, some prominent firms are not measured.
Marathon Health, OurHealth, and Premise Health Consistently Deliver High Satisfaction
Viewed as a strong partner, Marathon Health is the clear performance leader in this market. Clients report decreased insurance costs, positive health outcomes (including improved management of weight and chronic conditions), and high satisfaction with the firm’s wellness and lifestyle coaching and proactive approach to employee health. OurHealth—who has a much smaller customer base—also fosters strong client partnerships, which include frequent communication and regular meetings. Clients have seen tangible results and highlight the firm’s support and flexible services offering, which focuses on wellness. Premise Health partners well with clients, who highlight the quality of the firm’s clinical staff. Several praise Premise’s value in keeping insurance costs down and delivering high-quality services for less than other firms. Clients describe Premise as innovative and forward thinking in finding ways to improve outcomes. Conversely, satisfaction with Activate Healthcare has dropped more than 10 points (out of 100) over the past year. Many clients feel they have not achieved tangible outcomes or received the reporting they expected. More details on Activate Healthcare’s performance are given below.
Clients Report Lack of Needed Partnership from QuadMed and Activate Healthcare
Many clients of QuadMed and Activate Healthcare do not view their firms as innovative or forward thinking. Clients would like these firms to be more proactive in sharing ideas about how to improve employee health. Dissatisfaction with QuadMed stems from poor reporting for tracking outcomes, poor administrative communication, high staff turnover, and a sense that QuadMed isn’t invested in client success. Many Activate Healthcare clients report similar concerns. They say communication with the administrative side is poor and the reporting is severely lacking, leaving them with
no way to track outcomes. According to clients, Activate Healthcare has recently changed their approach and
used to be better at meeting clients’ expectations and delivering value.
CareHere Stands Out with Disciplined Approach to Reporting and Outcomes Tracking
Most CareHere clients are extremely satisfied with their ability to track outcomes and with the firm’s detailed, accurate reporting, which includes both scheduled reports (on utilization, top diagnoses, top medications, and financial outcomes) and on-demand reports, including ones that allow employers to identify key opportunities for population health improvement. Most Marathon Health clients also report strong satisfaction with their outcomes tracking. Clients are able to see how much money they have saved by reducing health plan utilization, and they speak highly of the firm’s ability to help populations better manage chronic conditions. Premise Health clients find the firm’s on-demand utilization and clinical-outcomes reports valuable. They say that Premise provides a wide variety of reporting, covering everything from clinical care, to wait times, to cancellations. A handful of clients would like better ROI reporting. Activate Healthcare is the only firm to have no clients report the ability to track outcomes. Poor reporting is the firm’s biggest weakness and impacts client ratings in other areas. Only one-third of QuadMed clients are happy with their ability to track outcomes. Most dissatisfaction stems from clients’ inability to clearly measure an ROI.
Vera Whole Health and Cerner Clients Find Value in Firms’ Proactive Wellness Efforts and Community-Centered Approach
Vera Whole Health clients say the firm is proactive in promoting clinic awareness in the employee community—holding health fairs, classes, biometric screenings, wellness checks, and flu shot clinics. Additionally, the firm regularly communicates with employees about national health trends (e.g., seasonal flu). Clients describe Cerner as eager and proactive in increasing clinic awareness and utilization—the firm holds health fairs, biometric screenings, and flu shot clinics; distributes flyers and marketing material; and reaches out to employees about education and wellness. Marathon Health engages with employee populations directly by setting up pop-up clinics, hosting seminars and classes, printing and distributing flyers to promote the clinic, and actively reaching out to employees when they need to be seen. Marathon Health regularly meets with employers to discuss population health trends and preventive measures that can improve employee health.
Marathon Health Seen as Most Strategic in Envisioning Future of Employee Health
Marathon Health clients appreciate the firm’s strategic help, such as their willingness to stay on top of the newest technology and offer a holistic approach to employee wellness. They note that Marathon Health considers factors other firms do not, such as social and economic determinants of health. Premise Health works directly with employers on new initiatives, such as telemedicine, and often shares ideas on how to improve employee health and save money. Clients view Premise as a thought leader but have yet to see the impact of many of the firm’s ideas. CareHere clients say the firm works extensively with them to analyze benefits spending and identify opportunities to improve employee health while reducing cost. Conversely, QuadMed doesn’t provide the guidance that employers expect. Clients state that while the firm does well at treating patients, they don’t do much to proactivity create a vision for the future. A couple of clients are hopeful the firm’s new leadership will encourage more strategic partnership.
PERFORMANCE BOTTOM LINES
Activate Healthcare
Quickly growing, with strong Midwest presence. Recently acquired by Paladina Health. Won Best in KLAS for worksite health services in January 2019. Satisfaction has since dropped; some clients question Activate’s ability to drive tangible outcomes, reporting poor delivery of needed insights regarding ROI and other metrics. Most clients still generally satisfied with how firm operates. Lack of proactivity on administrative side has weakened client enthusiasm.
Representative Customer Quote
“Activate Healthcare has been honest and up front with us. They helped us have realistic expectations for hiccups that would happen and learning curves we would encounter. At times, the high volume of traffic at the clinic can be challenging because the clinic wasn’t quite as prepared as they needed to be. But at the end of the day, we are pretty happy with the investment we have made in Activate Healthcare. We will need to see how we do financially over the next year to see how the services are making a difference.” —VP, Human Resources
Carehere
High-performing firm with employer clients in a variety of industries; many clients are smaller or midsize. High-quality patient care is a self-proclaimed strength. Clients appreciate firm’s ideas for improving employee health. Many report real outcomes in the form of lower healthcare costs and better overall employee wellness. Acts as wellness service but also as many employees’ primary location of care.
Representative Customer Quote
“In a partnership, we depend on our partners to bring their expertise to the table. We don’t know how to ask the right questions; we don’t do healthcare as a business, so we depend on CareHere to provide that leadership. They are a good strategic partner because they give us what we need, not what we want, and help us understand why we need to make certain decisions.” —Manager
Cerner
Unique in offering both HIT software/services and employer clinic/health services. More than one-third
of clients say Cerner does little to exceed expectations;
not viewed as very strategic. Majority of respondents happy with clinical personnel; some report issues with staff turnover or lack of training. Employers say Cerner is becoming more proactive in suggesting ways to improve employee health; they would like continued efforts
in this area.
Representative Customer Quote
“In strategy meetings, we have to present a lot of ideas to Cerner. I feel like we are always bringing ideas to them. It is rare when they come to us and say they have thought of something that might work for our population or culture. . . . [But] our relationship with Cerner is good, and the clinic staff members are great. They operate well, and we very rarely have to get involved with their day-to-day operations. . . . We have a very high satisfaction rating from our employees. I am glad that Cerner is creating that kind of relationship. They do a really great job.” —Manager, Human Resources
Marathon Health
Geographically broad with diverse client mix across multiple industries. Self-described focus is wellness and population health. Clear performance leader—84% of respondents highly satisfied; only one reports dissatisfaction. Particularly praised for communication, focus on keeping employees healthy, and regular, detailed reports on financials and employee health. Clients report increased employee morale and benefits satisfaction and high savings compared to traditional health plans. Viewed as forward thinking.
Representative Customer Quote
“Our relationship with Marathon Health has turned into more of a partnership than a vendor-customer relationship. I feel like Marathon Health really understands who we are and what we are trying to achieve. . . . The clinical staff members from Marathon Health are great. They are just top notch when it comes to being truly focused on prevention rather than diagnoses or prescriptions. The staff members really try to discover key ways to prevent conditions so that patients don’t have to deal with worse things in the future.” —Wellness Manager
OurHealth
Newer to market than other firms. Has relatively small but growing client base, mostly concentrated in Indiana. Somewhat uncommon model in which most clients use shared health centers rather than on-site clinics. Stands out for driving outcomes, including reduced employee healthcare costs and improved weight management, diabetes management, and overall wellness. Delivers detailed reports and meets with clients regularly to discuss employee health trends and potential improvements. Uniquely, described as proactive in examining claims data for ways to improve costs and outcomes.
Representative Customer Quote
“OurHealth was more flexible and capable of meeting our needs than other vendors. They could run our incentive program and were willing to do health coaching over the phone. Also, they pushed our remote associates and engaged them. I like that OurHealth will customize reports to meet our needs. We wanted to engage with a company that would provide us with multiple services, not just an on-site clinic. OurHealth has done some services for us.” —VP, HR
Premise Health
History includes a number of acquisitions and new growth, leading Premise to have the largest worksite health services customer base. Works with a lot of different employers; may be best known for working with very large companies and having very broad range of services. All interviewed clients would choose Premise again. Noted for proactive approach to employee health. Clinical staff is high quality and exceeds client expectations. Clients claim Premise’s on-demand reports (on a variety of subjects, including financial/ROI) contribute significantly to the firm’s ability to drive tangible outcomes (e.g., improved employee health and wellness); these outcomes lead to perceptions of high value.
Representative Customer Quote
“Premise Health has been continually great to work with. They listen to their clients, even though they struggle to deliver new things. It sometimes feels like they take a long time to do things, but other than that, I can’t think of one thing I would change about Premise Health. I like their team members and how the leadership team is so approachable. I can go to any senior leader and get what I need. Premise Health works with us on cost all the time. They spend our money as if it were their own, which is nice.” —Director, Human Resources
QuadMed
Well known in worksite health services with large customer base and large number of clinics across the country; originated in early 1990s with parent company and first customer, Quad/Graphics. Lowest-performing firm by a wide margin, earning the lowest ratings in every area KLAS measures. Clients don’t feel QuadMed partners with them to improve employee health; these perceptions contribute to particularly low ratings for executive communication and ability to drive tangible outcomes. Nearly half of interviewed clients feel nickel-and-dimed, negatively impacting perceptions of overall value. More than three-fourths do not feel their expectations were exceeded.
Representative Customer Quote
“QuadMed has done a good job of developing the clinical staff, and the partnership we have with the staff has been outstanding. The partnership with the corporate people is where we have struggled. . . . QuadMed’s corporate people do not really listen very well. They don’t give the providers an opinion on things, and they have a hard time delivering actionable items on our strategic needs. We frequently have to ask for requests multiple times, and by the time we get something, it isn’t what we are looking for.” —VP, Human Resources
Vera Whole Health
Small company based in Seattle, Washington; clients concentrated mostly in the northwest. Positions themselves as being focused on social factors and community involvement, not just workplace health and wellness. Performs relatively well. Perceived money’s worth is (slightly) higher than any other firm’s. Doesn’t appear to be cheaper, but respondents say that the things they are charged for “provide value” and that Vera consistently underpromises and overdelivers. 90% say Vera exceeds their expectations.
Representative Customer Quote
“Vera Whole Health has underpromised and overdelivered consistently. We haven’t seen any hiccups. We expect hiccups with any vendor. Vera Whole Health’s planning is very thorough and comprehensive. . . . Vera Whole Health has delivered exactly what we have talked about, wanted, and agreed to. They exceed our expectations. . . . We would like [them] to take more chances. They should be willing to be more creative. They have been creative to some degree, but they are slow with that kind of thing.” —CEO
Other Validated Firms
Healthstat: Partnered with Johns Hopkins in 2019 to provide healthcare delivery and fulfillment services for Johns Hopkins employer-sponsored health clinics and programs. Clients give the firm kudos for offering urgent/acute care services as well as wellness services/coaching, pharmacy services, proactive disease management, and patient-follow up.
Paladina Health: Ownership (i.e., investment) structure recently changed from DaVita to NEA. Acquired Activate Healthcare (also measured in this report) in early 2019. KLAS spoke to a small number of Paladina customers, but not enough for performance data to be shared.
FIRM-PROVIDED INFORMATION
Firms' Approaches to Worksite Health Services
Firms work to differentiate themselves across various capabilities and initiatives. These factors, if executed well, should come together and inherently contribute toward overall employer perceptions and ratings. If not executed well, these factors may lead to frustration.
Most clients are not intimately familiar with all of their firm’s capabilities or approaches, nor do they feel they need to be. In fact, employers often engage with a third-party worksite health services firm because they want to focus on their core business rather than on healthcare or healthcare delivery.
With this in mind, and recognizing that additional information may be helpful to employers as they look to make a selection decision, KLAS invited the firms measured in this report to provide perspectives on their approach in a number of areas. Their responses are too lengthy to include here but are provided in the full report.
Note: Firms’ responses are intended to provide additional understanding and context and did not impact the performance ratings given by clients.
RESEARCH CONTEXT
About KLAS
Driven by a mission to improve the world’s healthcare, KLAS is a healthcare-focused research firm whose data helps provider, payer, and employer organizations make informed software and services decisions. Powered by insights and experiences discovered in the 25,000+ interviews that KLAS conducts with these organizations each year, KLAS’ work creates transparency in the healthcare market and acts as a catalyst for software vendors and services firms to improve their offerings.
Research Methodology and Scope
In this report, KLAS research findings consist primarily of ratings and experiences from actual customers (i.e., employer organizations) who have contracted with a services firm for worksite health services (i.e., on-site/near-site clinics). Various factors contribute to customer experiences, such as cost, services offered, customer needs and expectations, and perception of firm’s service delivery. While respondents represented in this research have varying titles, KLAS spoke primarily with the HR professionals who engage closely with their organization’s worksite health services firm. The research that KLAS does is based on organizational feedback regarding their clinic firm and does not measure patient satisfaction from patients themselves.
KLAS data and scores are meant to reflect practical, not statistical, significance. For each firm rated in this report, KLAS had meaningful, candid interviews with at least several, but in most cases 6–12, unique customer organizations. To obtain ratings and feedback on firms, KLAS relies on client lists shared (confidentially) by firms, as well as on internal research efforts and industry connections. When a client list is incomplete or firms are resistant to providing client lists, it can be challenging for KLAS to reach the sample sizes required for performance ratings to be published. When the sample size for a particular question is less than 6, no score is shown.
Writer
Elizabeth Pew
Designer
Jess Wallace-Simpson
This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2024 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.