Transforming health care takes vision, determination, and often a “why not” attitude. In this case, it began in 1991 with a part-time secretary working in occupational health. Over the next 13 years, Traci Rothenburger, now Clinic Manager at Nordic PrivateCare, would apply her administrative, organizational, and people skills to improve her coworkers’ lives while helping her employer control their health care costs.
Traci began in occupational health at Seats Incorporated, a subsidiary of the family-owned Nordic Group of Companies, Ltd., and soon expanded that program to include wellness and health programs, and eventually opened an on-site clinic. She was then recruited to its sister company, Flambeau Inc., where she replicated and built upon that model, opening another on-site clinic, Nordic PrivateCare.
Nordic PrivateCare offers comprehensive, high-value primary care to employees and their families. They can get physical therapy, prescription fulfillment, orthopedic care, and more. The results of Traci’s efforts are impressive; employees are getting excellent care and reporting high levels of satisfaction with the clinic, while Flambeau enjoys a healthier workforce and more control over their costs.
It Starts From The Heart
Traci got her start in occupational health because, as she put it, “I was a dairy farmer, and health care was sorely needed for dairy farmers, so transitioning to occupational health care was my way of being able to get health care for my family… knowing it would be important for other dairy farmers as well.”
Working in occupational medicine, Traci worked with and listened to many employees, and year after year, it was apparent that they needed both better quality care and to cut their health care costs.
“A colleague of mine started an on-site clinic at his company back in 2000, when on-site clinics were very new,” explained Traci, “So what they were actually going to look like, nobody knew, but it was a need. And from that point on, the seed was planted.”
At the same time, Nordic Group’s board was brainstorming ways to better manage their health costs while providing a quality benefit to their workforce, so together, they decided to create an on-site advanced primary care clinic for Seats as a test – and if it proved to be a favorable experience, they would roll it out to its other locations.
Indeed, it proved successful – saving money for both Seats and its employees – so Nordic Group followed through with their plans and began establishing Flambeau’s in 2013.
Providing Proper Care with Nordic PrivateCare
Partly due to smaller physician’s offices being bought and consolidated into larger systems in the area, Flambeau noticed their employees’ needs were not being met by their traditional, fee-for-service health care options. Having demonstrated the ability to lead the creation of an on-site clinic, Traci was brought on board to establish Nordic PrivateCare at Flambeau, and she designed it to meet the total needs of the patient.
“Traci came in and did a great job, having applied what she’d already learned, and helped establish and develop and lead the clinics in terms of really making a difference in our business,” said Jason Sauey, President of Nordic Group of companies.
Despite keeping some of the same provider contracts she established at Seats, Traci said her biggest challenge in creating the new on-site clinic was finding providers they could utilize that offered high-quality services at low costs.
“I think the biggest success story for us was contracting with a broad scope of providers and services,” she continued, “between SmartChoice, Quest Diagnostics, St. Clare, and Reedsburg Hospital, we developed those relationships to make it all work together while remaining a cost-effective benefit for our employees.”
From a financial perspective, Jason said his chief concern was not knowing if their workforce was large enough to support the clinic – which Flambeau proved to be – but it took longer than they expected for that to become apparent.
“It’s an ongoing challenge as a self-funded plan, and there were years we paid out more in health care costs than we earned, so you have to continue finding ways to deliver better benefits at better costs,” he explained.
But Nordic PrivateCare wasn’t immediately thought of as a big benefit by Flambeau’s employees, either. As Jason explained: “It was an odd circumstance. We couldn’t seem to get it to catch fire at first, but over time, as people started to use it and word-of-mouth spread, and it came together pretty well,” he explained. “It’s been a long time coming, but it seemed that people simply had to experience it to truly appreciate its value.”
Incentivizing Employees with QualityPath
The clinic’s eventual success was, in part, thanks to properly incentivizing employees to use its services.
“We use QualityPath quite a bit, so we really ask the patient to come and to talk to us first before undergoing a surgical procedure or having a test performed. And when they go, we pay their mileage. If they need to stay overnight, we pick up the room expense for them, too.”
QualityPath by The Alliance offers a bundled price for several tests and procedures, which significantly reduces the out-of-pocket expenses for patients. It also includes built-in patient navigation, a warranty on select surgeries, and less paperwork.
Traci said they also incentivize through their wellness program, which uses a points-earned system, and that employees pay $5 per week towards specific goals. If they complete the program, they get all the money back. She thinks it’s a nice incentive they get back that also goes towards their health and wellbeing.
On-Site, On-Demand, Comprehensive Care
Now that its employees know the clinic’s many benefits, Flambeau is reaping its rewards as a recruiting tool – not only to bring people in – but to improve the health of their current employees by providing a better quality of care. The patients that use the clinic receive more personal care, too.
“It’s more about spending time with our patients and employees than anything,” said Traci.
We like to have our patients come in and be seen and treat the whole person – not just the symptoms or the part that’s hurting them at that point in time.
And when patients do come in for treatment, Nordic PrivateCare offers a wide array o f services to take care of them.
“I think very few clinics offer as many services to their employees as we do,” said Traci.
Indeed, Nordic PrivateCare has an extensive offering, from prescription fulfillment to urgent care and everything in between.
“We have massage therapy, chiropractic services, behavioral health, on-site radiology and imaging services, and we actually just added orthopedic consultations as well,” Traci remarked.
And if that’s not comprehensive enough, the clinic also introduced an ER program where if somebody needs to be seen, they can call the clinic day or night, seven days a week. As a result, their ER utilization has dropped off significantly.
“All they have to do is dial, and the on-call person will guide them through the process,” explained Traci. “So, whether that patient needs to go to urgent care, the ER, or if they can wait it out until the next morning to come into the clinic, they get real, actual guidance.”
Jason added that the on-site clinic’s accessibility was a huge plus over traditional health care models, too.
“Between the convenience, the quality of care, the level of connectivity between the providers and the patients, and the cost management aspects, it’s a win-win for us and our employees,” he said.
Controlling Costs with Advanced Primary Care
Jason emphasized that the primary reason they started the clinic was not to just mitigate high costs for the benefit of company, but also its employees.
“If we can keep our costs down, it helps make sure that their deductible and their contributions are reduced as well,” he said.
“As a private employer and having a self-insured plan, we’re going to feel the full brunt of the cost of our experience – and that’s a good thing – I far prefer that to purchasing [traditional] insurance,” he continued. “And although it’s difficult to be completely deterministic about the effect that the clinics have on our costs, I’m confident they’ve helped us slow the rise, if not reduce them.”
Jason then explained that their primary cost metric estimates they’re spending under $7,000 per employee per year in health care, which is a lot lower when compared to most other employers.
“From everything I’ve seen, that’s far less than almost every survey I look at – which has most of them running around $12k-$14k a year.”
He also credited those savings to guiding – what he calls “steering” – employees to lower-cost practitioners and providing more appropriate treatments for a given condition at a particular stage.
In other words, the clinic has provided proper care navigation for employees, saving both them and their employer from spending money on unnecessary tests and procedures.
Providing Proper Care During The Pandemic
The clinic also offers telehealth services, which have come into national focus during the COVID-19 pandemic.
By performing virtual medicine from the clinic, we’re cutting costs and providing accessible care to the people that need it – whether that’s cholesterol checks, someone’s hypertension being taken care of, or urgent care needs – we want to make sure we’re offering care during the pandemic.
The remote care offering at the clinic has been so successful they’ve deployed it to five other locations: Arizona, Georgia, Indiana, and two in Ohio.
Despite its virtual success, Jason believes that Nordic PrivateCare’s on-site services aren’t going away anytime soon. He said there’s no real substitute for great in-person care because people like Traci help elevate employee engagement.
“Traci is what makes the clinic so great. She engages and does the outreach and shows that she personally cares for not just the employees but also the people who work in our clinic. When we make that connection with our people it has a greater impact.”
Nordic Group’s Three-Legged Health Care Stool
From the beginning, they’ve referred to Nordic Group’s three-legged stool to serve as the foundation for their health care management, as explained by Jason below:
- Education – “There’s very few topics people are less equipped to deal with effectively than managing their healthcare; we need to help educate those people. We have an obligation to help manage their education, and Traci does a good job of helping people understand what’s at stake here, what work is involved, and how to be proactive about their health.”
- Steerage – “We’re focused on making sure we find the right provider, for the right patient, at the right location, at the right time.”
- Leverage – “A strong focus for us is managing costs and making sure we have strong relationships with good providers that will give us cost-effective solutions.”
Room For Improvement
Traci explained that Nordic PrivateCare’s plans more or less remain the same. “We want to continue doing what we’ve been doing. It’s a great benefit to our employees in regard to accessibility, convenience, quality of care, and cost-management. We’re really pleased with our clinic; we just want to improve upon it.
Jason agreed, adding how they’re constantly monitoring their employees’ attitudes and the health policy landscape: “There will continue to be changes in the health care environment, and I don’t necessarily think there are forces out there making it easier for employers, so as we continue to have new situations, new circumstances, and new laws, we’ve got to be on top of it by responding quickly and effectively to keep the clinic relevant and helpful to our people.”
Other goals for 2021 include increasing the clinic’s utilization by bringing more of their employees’ families into the clinic.
“We particularly want to improve what we might call our ‘outlier locations,’ the locations that don’t have quite as many people,” Jason explained. “It’s a greater challenge to have a continual on-site presence at those locations, but it’s something that’s important for us.”
Find A Leader, Start Small, And Fail Forward
When asked if she could offer advice to other employers thinking about starting an on-site clinic, Traci said to just jump in and do it – start small, and rest will follow.
QualityPath is actually how it all started for us. Whether it was that or contracting for imaging or contracting with hospitals to do some of our smaller services, it was just starting small and expanding upon it.
Jason’s advice for employers was simple: find someone like Traci.
“I think the biggest thing is to find a good person who you can have great confidence in to lead it. What impresses me most about Traci is that she’s always staying alert and learning, and as she learns, she’s finding ways for us to improve our offerings and how we deliver our services through our clinics.”
Jason also added that it might be difficult to make an on-site clinic work if you’re a small employer. He estimates that at least 120 employees are required to make it work, and if you’re smaller, going the shared-site clinic route might be more appropriate.
Beyond that, I think it’s just about experimenting; don’t be afraid to try new things. If you learn that something’s not working, fail fast and move forward doing something different. That’s the most important thing: continue to experiment, and if you find something that’s working, do more of it.