ORLANDO -- Like employers of all types, colleges and universities have steadily watched their spending on health care rise. They've tried all sorts of tactics to try to control that spending, but many of them -- especially those that entail cutting benefits or shifting the cost burden to faculty and staff -- understandably have little appeal to the institutions or to employees.
But what else to do?
Mount Vernon Nazarene University, in central Ohio, is among a small number of institutions trying to exert more control over health care spending and more influence over employees' health by offering them primary medical care right on the campus.
Officials from Mount Vernon Nazarene, which has about 350 full- and part-time employees, described their efforts (along with representatives of the companies that help them manage their on-campus clinic) at last week's annual meeting here of the College and University Professional Association for Human Resources.
Patrick Rhoton, the university's director of human resources, says that its self-funded health insurance plan has, like most others, seen its annual costs grow significantly in recent years. Cutting those costs in the short term is difficult if not impossible without diminishing the benefits provided to employees, but over the long term, the best strategy for bringing down spending on employee health care is by improving workers' habits and, ultimately, their health, Rhoton says.
Among the largest drivers of increasing health care costs are individual behaviors such as overeating, ignoring medical advice, forgoing regular checkups, and failing to fill prescriptions, says David C. Hooper of Novia CareClinics, Inc., which has set up the clinics at Mount Vernon Nazarene and numerous school districts and other employers. Improving the health of employees (and their dependents) is also the "only method of controlling costs that is within an employer's control," says Hooper. "Healthy employees use health care less, and we have to affect health if we're going to affect cost."
Paradoxically, the cost shifting in which many institutions have engaged -- requiring employees to pick up a greater share of their own health care costs -- often deters workers from some of the behaviors that might keep them healthier, prompting them to put off preventive treatment, fail to refill prescriptions, etc.
It was to try to address those problems that Mount Vernon Nazarene established its clinic.  With an initial investment of about $10,000 to turn an underutilized building on the campus into a two-exam-room facility, the university set up a clinic to provide primary care services free of charge to the roughly 70 percent of its employees (and their dependents) who participate in the institution's self-funded health insurance program. (Students get treated through a separate campus facility.)
Employees who opt to use the on-campus clinic (it is voluntary) sign up online for 20-minute appointments with the on-site physician and registered nurse during the 12 hours each week that the clinic is open (for now -- the university may expand those hours if demand grows). If they need lab tests that the clinic is equipped to provide, those too are free, as are generic prescriptions that the clinic has in stock. And while seeing a doctor in the area often requires a trip to Columbus an hour away, sometimes eating up a half-day, Mount Vernon Nazarene employees can squeeze in visits to the centrally located clinic over lunch or the equivalent.
Importantly, from Rhoton's standpoint, the clinic (through its partner, Novia Care) also provides patients with a personal "health coach" who helps them stay on track with treatments or answers questions between appointments.
With the clinic in place just one year so far, Rhoton acknowledges that it's too early to gauge its success in a meaningful way. Early signs are encouraging, though, he says; employee feedback has been positive, and while it will take the institution some time to recoup its upfront costs, "right now we're paying less on physician services through the clinic model than we would [on the employees who use the clinic] through health insurance," he says.
The clinic model can run into problems in some settings, says Hooper of Novia Care. Some employees might be reluctant to use an employer-run clinic because of privacy concerns (Will my boss learn about my secret smoking?), and others might have concerns about the quality of the limited physicians and nurses.
But as technology and other changes have helped drive down the cost of providing primary health care in a clinical setting, Hooper predicts (with some obvious self-interest, granted) that more and more employers will go this route.
A handful of other colleges have done so. On a completely different scale, Florida International University in August unveiled a $2 million facility to provide family and internal medicine to its faculty and staff members and their dependents, says Fernando Valverde, associate dean for community and clinical affairs at the university's new medical school. (The university plans next year to add specialty care services for both staff and students.)
While the FIU facility barely resembles the modest operation at Mount Vernon Nazarene, it is motivated by many of the same goals, says Valverde, who notes that medical costs for Florida International's employees run close to $50 million and that coordinating care for employees under one roof could help bring down those costs.
The University of Miami put in place a clinic on its medical campus last spring that provides acute care to all employees eligible for benefits, says Jennifer Cohen, executive director of benefits administration at Miami. The university has begun slowly, "since we didn't know what demand would be," but plans to add a second clinic on its main campus early next year, and "it's likely that we will eventually expand to things like annual physicals and other wellness-related services," she says.
Use of the facility so far has been less than expected, Cohen says, but that's likely to change soon: "With flu season approaching, we expect to grow more than steadily over the next few months."