Premise Health: A threat or opportunity for hospitals?

Premise Health is accomplishing for employers what hospitals nationwide strive for — decreased care costs.

The Brentwood, Tenn.-based direct primary care company partners with employers to open onsite health and wellness centers. Most of the employers Premise Health partners with are self-insured, meaning they take on the entire financial risk for their health plans.

In total, Premise manages nearly 600 health centers in 45 U.S. states, Guam and Puerto Rico. More than 60 of these health centers are designated as patient-centered medical homes by the Accreditation Association for Ambulatory Health Care.

"Our goal is to provide a comprehensive healthcare solution that offers easy access to quality care," says Premise Health CEO Stu Clark. "We provide care directly to the workforce and their families through an onsite or near site medical home, which, by design, has aligned incentives with the employer, patient and provider."

Mr. Clark acknowledges Premise's model can potentially create a conundrum for some hospitals, since employers see cost savings from commercially insured patients using the onsite health centers instead of hospital-owned facilities.

But he says the approach goes beyond lowering costs and is seen by employers as a valuable addition to their benefits offerings and a way to increase productivity.

Mr. Clark explains, "We work directly with our employer partners to communicate the value of these health centers to their covered populations, which drives utilization. The more patients we see, the better preventive care and treatment we can provide, and the healthier that workforce becomes. And we know that healthier people lead to healthier companies."

Case study

Kinder, La.-based Coushatta Casino Resort partnered with Premise in 2011 to manage its onsite health center and improve the overall health status of Coushatta's employees and their families. As a result, the resort, which is located in a rural setting, has seen better outcomes and has saved nearly $4 million in healthcare costs. That's more than the total spending for the onsite health center.

Before partnering with Premise, resort employees would spend hours away from work for a medical appointment, or they wouldn't receive routine care at all, says Bill Gadberry, Coushatta director of human resources. 

But Mr. Gadberry says things have changed, and an increased number of employees now receive care at the onsite health center, which was an existing site that did not change locations after the Premise partnership, due to its convenient location, short wait times and services offered. Since partnering with Premise, utilization of the health center has risen due to changes in scheduling and hours of operation to better accommodate employees.

Mr. Gadberry cited Coushatta's benefit plan, which covers 3,200 people and is particularly centered on the clinic, as the primary reason people come to work at the resort and the primary reason they stay.

"Our associates are just ecstatic about the onsite clinic and the benefits we provide, so it has been a great recruiting and retention tool for us. But it's also the center of our culture. A culture based on providing excellent customer service and taking care of others, including our associates,” he adds.

Opportunity for hospitals

Although Premise helps employers achieve better outcomes and lower healthcare costs, hospitals should see Premise as an opportunity rather than a threat, says Mr. Clark.

Premise is a primary care business, offering services such as pharmacy, physical therapy, fitness, dental, vision and occupational health. Since Premise does not provide secondary or tertiary care, the physicians at Premise health clinics refer out to specialists. For patients who need inpatient care or diagnostic and imaging services, it is crucial the company has a hospital or community partnership to ensure patients receive necessary treatment, Mr. Clark says.

Since Coushatta has a high-risk population, Premise says it worked with the employer to establish a relationship with local physicians and hospitals that agreed to take patients who needed specialty or inpatient care. Mr. Clark says this is beneficial to multiple parties — the patient, the client and hospitals. He explained: "Patients who have already been diagnosed at the Premise health center do not need to endure — or pay for — repeated tests and office visits with other providers before receiving inpatient care." He says employees who receive timely, needed care are healthier, more productive, and can return to their jobs sooner. And he says patients at Premise facilities are referred to local hospitals and physician.

"I think the forward-looking hospitals and health systems will choose to see our presence as an opportunity," says Mr. Clark. "Those hospital partners that see the opportunity understand Premise is there to uncover disease in that workforce, so from a preemptive point of view, we're a big believer in the need for referral, and the need for diagnostics and the need for imaging. So we're going to uncover a lot of health issues that require hospital and community resources."

The vast majority of Premise's 600 locations enjoy some informal relationship with a hospital or system, meaning there is a cooperative approach with referral and exchange of health information. When those relationships don't exist, Premise refers patients to other nearby facilities if they require secondary or tertiary care.

But overall, Mr. Clark says, Premise's most successful operations around the country are when they have a relationship with the local medical community, particularly a hospital.

"In that scenario, the employer wins, the patient wins, the hospital wins and Premise wins. We are much more effective when we have a hospital partner," he adds.


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