What is an "Onsite" or "Near-Site" Center?
A workplace “onsite" or "near-site center” is a setting where an employer or union offers one or more medical and wellness services, delivered by licensed providers, to all or a designated portion of its active population and other eligible individuals. Today’s centers are often referred to as “health and wellness centers,” due to the wide range of first aid, occupational health, acute, primary, specialty, condition management, wellness and ancillary services offered at the location.
Many started as occupational health clinics, treating minor injuries and serving workplace health and safety needs, but have expanded in to primary care and other areas. On-site occupational health centers offer critical services like injury treatment, drug testing, & more.
Today's worksite centers are often considered "advanced primary care" settings, led by either physicians or Nurse Practitioners or Physician Assistants. The provide coordinated primary care and condition management, as well as wellness and episodic care.
It is commonly part of the health benefit options that an employer offers to its workers. IT also can be part of a union's member benefits. While most health care clinics are located in close proximity or within or "onsite: at the workplace, a growing number are located outside, but with easy access to the worksite. A "near-site" clinic may be used due to the lack of space at the main location or to ease access for those living or working in more distant or remote locations.
Another option for employers and unions - both large and small - is to share a near-site center. A near-site center that is located in an area where multiple employers are operating, or where workers live enables an employer/union with a smaller workforce to provide a center benefit with little or no capital investment. Another approach for smaller employers/unions or those with multiple or remote locations is to offer mobile vans that come to the worksite or multiple worksites of an employer.
Finally, we're seeing an increasing use of "virtual" centers or services to a workforce. A virtual center is unlike a telehealth or nurse call line in that the providers are often the same as an employee would see in the brick and mortar clinic at work or they are the same providers each time the patients calls. These services are being used to provide initial triage to determine if the patient actually needs to see a provider in person or if the health concerns can be handled by a provider remotely.
Often, the virtual provider will use a person's cell phone camera and microphone to identify problems. In some cases, there is a cart or kiosk the patient would use that has equipment to allow the remote provider to obtain vital signs to determine the patient's condition and need for in-person care or prescriptions.
The objectives of all these approaches are to provide easy access and immediate attention, at little or no cost, for a host of services and products that an employee would normally have to leave the worksite to obtain.
As a result, worksite centers, offering a variety of settings and staffing, are quickly gaining in popularity, especially among mid-large employers of all industries. These facilities may be sponsored by public or private employers, union groups or other plan sponsors. Even smaller employers can have a nurse or other provider offer screenings, preventive care, coaching or minor services at minimal cost and still reap the benefits.
Employer-sponsored worksite center are all unique, reflecting the demographics, culture, geography and clinical needs of the employer and its workers, as well as the medical resources available in the local community.
Benefits of an Worksite Center
There are many reasons why employers of all sizes should consider a worksite center, including:
How Worksite Centers Differ
Each worksite center's services, cost-sharing, use privileges and staffing, should be customized to meet the needs of a specific organization and employer benefit strategies. These must be reflective of the objectives of the sponsoring employer (i.e., lowering medical costs, offering convenient access to providers, improving health and productivity of the population, reducing unnecessary services) and the medical needs of the population.
In most instances, worksite center is limited to employees who participate in a given health insurance plan. However, as the value of the center becomes apparent to workers and the employer, other covered groups, such as dependents, pre-65 retirees, are deemed eligible to use the services. In over 60% of centers, the services provided by the onsite clinic are free or offered at lower rates than the standard network or community provider rate. However, it’s important to note that the IRS requires that "onsite clinics" charge a “fair market” rate to persons with HSAs who want to use a clinic that provides more than first aid care.
There are several models employers can choose to design, build and manage a worksite center: Employer-managed, Vendor-managed, Provider-managed, or a combination of these.
An employer can operate the center itself, hiring the staff as its own employees. About 5-18% are managed solely by the employer. However, most employers don’t want to take on the many compliance, staffing and management tasks so they contract for these services.
The vast majority of centers are contracted out to a third-party vendor to build, manage and staff the center. In addition, a growing number of centers (18-20%) are now run by hospitals or physician groups, who use or hire their own center and administrative staffs or utilize existing provider facilities to serve the employee population.
Finally, as stated above, an increasing number of employers are participating in shared, multi-employer centers, located either on one employer’s location or centrally located. These may be owned by the employers or the employers could contract with a provider or outside vendor who specializes in this type of center. The vendor will build, staff and manage the facility either at the request of a group of employers or will solicit employers in a specified geographic area.
Regardless of the model used, it’s key that employer remain engaged in provider selection, center oversight, strategic and policy direction.
Staffing practices vary from one center to another, though over 60% of facilities are led by a Nurse Practitioner or Physician’s Assistant. In many worksite centers, a physician may be present during all hours or part-time, alongside supporting nurses and staff. Some centers provide various pharmacy, specialty or ancillary clinical services such as chiropractic, massage, occupational therapy, physical therapy, dentistry, optometry, etc., depending on employee request or employer onsite clinic strategy.
In addition, a growing number are utilizing telemedicine vendors to supplement the services after hours or to those in remote locations. The vast majority of centers are not open nights, weekends or holidays.
NAWHC recommends employers ensure there is a connection with local providers by the center staff. This helps deal with the 40%+ of workers who come to the center and don’t have a personal physician, as well as to ensure continuity and coordination of care with those patients’ who have a doctor. This will avoid additional fragmentation of care.
Typically, worksite centers are either open full-time, meaning that they are open during the typical employee workday, or part-time, where they may be a set schedule of limited days or hours per week that the center is open. Some centers even offer after-hours or weekend availability. For locations with 24 hour shifts, the hours may be longer. Availability also varies depending on location of workplace and the number of employees.
The Increasing Use of Onsite and Near-site Clinics
In 2021 NAWHC and Mercer conducted a national benchmarking survey of employers of all sizes and industries. In the most recent survey, the key findings were:
NAWHC’s Role in Developing and Expanding Worksite Centers
NAWHC helps organizations of all sizes create and expand onsite and near-site clinics through its educational programs, benchmarking surveys, networking roundtables, website resources and research projects.
Our unbiased and objective information and opportunities for learning and sharing experiences will help you set your objectives and select the appropriate design, programs, measures, vendors and consultants to realize your onsite clinic vision and bring outstanding benefits to your organization and its employees.
For information on the value of membership and to obtain an application, go to our Membership page.