Employer-sponsored care presentsa number of benefits: better availability, convenience and qualityof primary care, all of which can prevent utilization of highercost services.

SpaceX, a company known for its revolution of space technology,is attempting to modernize another largely untraversed arena —employer-sponsored primary care.

A new peer-reviewed study from Collective Health and One Medical,published in JAMA Network Open, examines the impact of SpaceX'sholistic health care program, which integrates on-site,employer-sponsored health clinics with near-site and virtualprimary care. Among the treatment group (those with more than 50%of their primary care visits at on-site or near-site clinics),total health care costs were 45% lower than costs for a comparablepopulation receiving traditional community-based care — theequivalent of $167 per member per month (PMPM). The cost savingswere due to lower utilization of downstream care categories such asemergency care, hospital visits andprescription medications.

(Note: several of the study's authors reportedreceiving fees from One Medical or its affiliates, or fromCollective Health, which sells One Medical memberships toemployers.)

Related: 3 considerations for maximizing the value ofon-site and near-site health centers

"Combining virtual care with near-site and worksite clinics isproving to be a powerful way for employers to provide convenientaccess to preventive care, keep employees out of the ER, and loweravoidable costs," said Raj Behal, MD, MPH, chief quality officer atOne Medical. "When you create an effective healthcare home base foremployees, you can see significant cost reductions by eliminatingthe need for more costly downstream care."

The cost-of-care breakdown

Not all costs declined for members in the treatment group.Spending on primary health care rose by 109% ($20 PMPM) andbehavioral health care rose by 20% ($1 PMPM). Additionally, thesubsidized services cost employers more on a per utilization basis,with primary care encounters costing a mean of 33% more perepisode. Costs were higher for most other encounter types as well;mental health care and imaging were the only areas that saw lowercosts per episode.

Yet these spending increases were offset by much lower relianceon more expensive services, including:

• 54% lower spending on specialty care ($11 PMPM)
• 43% lower spending on surgery ($14 PMPM)
• 33% lower spending on emergency department care ($16 PMPM)
• 26% lower spending on prescriptions ($5 PMPM)

Utilization

Across the full population sample, 22.5% used at least oneaspect of the employer-sponsored care model, with nearly 10% usingthis model for most of their primary care. There was little overlapbetween members who used on-site clinics and those who usednear-site clinics: just 2.5%. Overlap with virtual care was higher,with 19% of on-site users and 33.3% of near-site usersparticipating in virtual services. Twenty percent of virtual usersnever made an in-person visit.

What does this mean for employers?

Employer-sponsored care presents a number of benefits: betteravailability, convenience and quality of primary care, all of whichcan prevent utilization of higher cost services. Additionally,study findings suggest that mental health services were used morewidely, potentially contributing to a healthier and more productiveworkforce.

But there are limitations to the findings as well. Though thepopulation samples were controlled for risk score, the studyauthors allow that members with fewer health concerns may haveself-selected into on-site or near-site care, while those withhigher health risks opted for a traditional care model.Additionally, the relatively low cross-utilization of servicessuggests that many members did not take advantage of the integrateddelivery systems.

One thing is clear: More research is needed.

"There's a lack of evidence on the effectiveness of emergingcare models like on-site and near-site primary care," said DrSanjay Basu, MD, PHD, director of research and population health atCollective Health. "It is essential to ensure that the evaluationsof these solutions are conducted in a manner that leads torigorous, peer-reviewed research for the community who decideswhether such models should be pursued."

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