NPs Implement an On-Site Health Clinic for Employees

On-site access to healthcare for employees and their families can decrease absenteeism and employee stress levels and improve production

Each year, American companies spend billions on employee illness and absenteeism. Businesses of all kinds, including medical clinics, struggle to meet higher insurance premiums associated with chronic disease and an aging workforce. These costs, combined with a lack of accessible healthcare, can produce catastrophic economic losses for independent medical practices.

In 2014, the United States surpassed $3 trillion in healthcare costs.1 Family health insurance premiums have increased by 114% since 2000.2Productivity losses due to employee and family health problems cost U.S. employers $1,685 per employee per year, totaling $225.8 billion annually.2

In 2015, the National Association of Worksite Health Centers reported that approximately 20% to 30% of larger companies offered on-site or near-site health services to employees. Many smaller companies (less than 150 employees) are finding that it is beneficial to employ NPs, PAs or physicians a few hours a week to provide employee health services.3

In my current specialty practice, an orthopedic setting with 130 employees, the owners provide insurance for employees and their family members. In 2013, the practice averaged three employee absences per day due to employee or family illness. Utilization of insurance for minor acute illnesses and chronic stable conditions was high, and the organization was hit with a 10% increase in insurance premiums in 2013.

These costs, combined with a lack of access to healthcare, produced a financial burden for the organization and can exact even more catastrophic economic losses for smaller independent medical practices. With the implementation of a new national healthcare system and a rise in insurance costs, the issue of access to care has become a national priority.

Literature Review

Published research shows that the implementation of a worksite employee health clinic can significantly increase employee health and morale, decrease absenteeism, decrease the number of worksite injuries, decrease employee stress levels, and improve production.4 Some studies suggest that an investment in employee health may lower healthcare costs and insurance claims, and that worksite health programs may produce up to 25% in savings on absenteeism and healthcare claims.1

The implementation of a workplace health program may offer many benefits to both the organization and employees. The benefits to the organization included a caring image, improved staff morale, improved staff retention, decreased employee absenteeism, and improved productivity. Benefits for the employees included improved health and self-esteem, improved morale, better health behaviors, and increased job satisfaction.5

Barriers and limitations include employee resistance or lack of participation, feelings of being forced to participate in a healthy lifestyle, and fear of retribution if choosing not to participate.6


In 2013, the board of directors for the practice determined that the company could benefit from offering on-site access to healthcare for employees and their family members. The board members viewed the creation of onsite access as a way to curb or reduce absenteeism and insurance costs. The goals of the clinic were to offer efficient, on-site, competent care to improve patient health outcomes, employee productivity and presenteeism, as well as to lower insurance premiums. The board decided to utilize the currently employed family nurse practitioners to provide accessible healthcare to the employees.

The board named a lead nurse practitioner (this author) to establish a plan for implementation. In Mississippi, where the practice is located, NPs are mandated to have collaborative agreements with physicians who practice within the same field of practice as the majority of the NPs’ caseload. Because the nurse practitioners’ current collaborators were specialists, I contacted local family practice, internal medicine and pediatric physicians to establish collaborative agreements.

Adjustments were made in the NPs’ schedules to accommodate the primary care patients among their existing specialty patients. Employee appointments for health checks and chronic disease management were made at the end of the regularly scheduled orthopedic appointments. Urgent care appointments were worked into the existing schedules.

Electronic health record templates were created through the collaboration of the lead nurse practitioner and management.

Educational meetings for all employees were held, during which the purpose, goals and benefits of the employee and family health clinic were reviewed.

Data were compiled through a third party, and quarterly cost analyses were performed to determine the effects the clinic had on health benefit claims paid.


The most significant limitation in the implementation process was the requirement for a collaborative practice agreement in Mississippi. The primary care physician shortage in the area meant the pool of potential primary care physician collaborators was limited.

Another barrier to the project was resistance from some local providers who perceived the employee and family health clinic might generate competition for established primary care practices. Continued communication revealed a general lack of knowledge among local primary care providers and their associated health organizations about the purpose and goals of the clinic as an on-site employee and family health clinic.

Finally, organizational limitations had to be overcome. These included insufficient supplies and equipment, time required for implementation, inadequate staff training, and employee education about disease processes and health habits.


To evaluate the effectiveness of the clinic after its first year of operation in 2014, management analyzed the total dollar distribution for health claims paid for employees and their family members covered by the current insurance provider, using data from the practice’s insurance carrier. Cost analysis for 2014 documented a decrease in cumulative paid claims, from $375,882.82 in 2013 to $305,573.37 in 2014. This resulted in an annual cost savings of $70,309.45 in health benefits paid. The significant decrease in health benefits paid led to a decrease in insurance premium contributions for employees from $106 to $60 monthly. In 2015, the total cost of cumulative paid claims from January 2015 through November 2015 was $255,296.26, equaling an annual cost savings of $50,277.11 over 2014.

Analysis of employee absences due to employee or family illnesses show that absences have stabilized since the clinic opened.

Staff appreciation of the benefits of the employee and family health clinic was established through a healthier employee pool with fewer work absences, increased productivity and improved disease management, as evidenced by less time off due to illness.

The initial resistance by local providers who were concerned about competition was reduced through reassurance and education about the purpose of the clinic. Eventually, collaborative agreements were established and continue to be successful.

Practice Implications

Perhaps the most impactful outcome — and one that should prompt other organizations to consider implementing a similar clinic — was the demonstrable cost savings. Family nurse practitioners who work in specialty practices across the country are uniquely positioned to propose and develop such clinics.

Due to a shortage of primary care physicians in rural Mississippi, the mandate for collaborative agreements restricts access to care. NPs collaborate daily with other primary care providers and with specialists in the community. NPs can further improve patient outcomes through greater access to care by having full practice authority. This can only be accomplished through increased participation of NPs in political action committees, increased membership in nurse practitioner advocacy organizations, and improved communication between governing and licensing entities about nurse practitioner education, training and leadership skills that greatly impact patient health outcomes.


  1. Kaiser Family Foundation. Health costs.
  2. Centers for Disease Control and Prevention. Control healthcare costs: Workplace health programs can impact healthcare costs.
  3. Boress L. Employers increasingly turning to onsite health centers. Institute for Healthcare Consumerism.
  4. Mitchell R, et al. Improving employee productivity through improved health. J Occup Environ Med.2013;55(10):1142-1148.
  5. World Health Organization Western Pacific Region. The WHO health systems framework.
  6. Olson A, Chaney J. Overcoming barriers to employee participation in WHP program. Amer J Health Studies.2009;24(3):353-357.

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