The document discusses how employer-sponsored on-site clinics can help manage healthcare costs if they implement a comprehensive medical risk management approach. It provides details on WeCare TLC, a company that operates on-site clinics using the patient-centered medical home model and analyzes data to identify savings opportunities and improve population health. WeCare TLC clinics have achieved high employee usage rates, reduced costs 15-25% for employers within 3 years, and improved health outcomes for conditions like diabetes and hypertension. Medical risk management is presented as the key to making on-site clinics successful in both improving health and reducing costs long-term.

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How to Generate an ROI
Through an Employer-
Sponsored Clinic
The medical risk management approach
Forward-looking employers are turning
to on-site (also known as near-site or
employer-sponsored) health clinics, an
innovative delivery mechanism to bring
health care directly to workers on the
factory floor or in the office complex.
Such clinics hold the promise of helping
to proactively manage costs, reduce
absenteeism and improve quality.i
In 2014, 32 percent of employers
with 1,000 or more workers offered
employee health clinics, according
to a Towers Watson-National Business
Group on Health 2013/2014 report.ii
The report’s authors identified offering
on-site care one of the top 10 tactics
for managing health care costs. A
2014 poll found that 29 percent of self-
funded employers with 5,000 or more
employees offered work-site clinics.
Smaller and medium-sized employers
are joining the national momentum by
teaming up to participate in on-site
clinics, in some cases through business
coalitions.iii
The founders of WeCare TLC, a medical
risk management company that uses
on-site clinics to manage employers’
population health risks, believe that
clinics are most effective when they
offer comprehensive primary care.
WeCare TLC, with 55 clients in five states,
does not just operate employee health
clinics; the company builds patient-
centered medical homes (PCMH).
WeCare TLC then uses those homes as
a platform for medical risk manage-
ment and for improving the overall
health of an employer’s population.
The company’s data analytics team
continually evaluates employers’ historical
and current health claims to customize
medical offerings, add services or more
tightly manage the network – all with
an eye to improving worker health and
driving down costs.
This paper will examine four significant
ways the WeCare TLC patient-centered
medical home model and compre-
hensive medical risk management
approach are improving employee
health and employers’ bottom lines.
Too often, on-site clinics fail to meet
their full potential. In September 2015,
global human resource consulting
firm Mercer published these troubling
findings:iv
45%
of self-funded employers’ workers use
clinics when they are offered.
58%
of self-funded employers say the
clinic helps members control chronic
conditions.
<50%
say their clinics are delivering a return
on investment.
U.S. employers are searching for strategies to provide high-value employee health
care. They want to more effectively manage health care cost trends – still rising at
more than twice the rate of inflation – and get the greatest value from dollars invested.
WeCaretlcPopulation Health Management

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65%of our clients’ workers use our clinics in
the first year. That grows to more than
80% in the second year.
99%of employees would recommend
WeCare TLC clinics to a fellow employee.
3 yearsEmployers covered the cost of the
clinic, eliminated medical inflation
and reduced overall health plan costs
within three years.
15-25%Employers lowered their health care
costs by 15 percent to 25 percent.
WeCare TLC’s results prove
the value of its approach:

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On-site clinics come in a variety of shapes and sizes. Most frequently, nurse
practitioners or physician assistants lead them. Some are led by physicians
or registered nurses. Nearly all employer-based clinics offer urgent care –
such as immediate care for upper respiratory or urinary tract infections, a
recent survey found. Most offer blood draws and routine preventive care,
such as vaccinations. Four out of five clinics offer wellness services and
two-thirds offer health coaching; between one-third and one-half of clinics
also offer pharmacy.v
The founders of WeCare TLC believe that to truly manage health plan costs,
on-site clinics must become the primary point of contact for all employees’
health care needs. Only then can providers build long-lasting, trusted patient
relationships that lead to better health. That’s why WeCare TLC clinics are
organized as patient-centered medical homes (PCMH), an evidence-based
model that lowers costs and improves quality.
What is a Patient-Centered Medical Home?
According to the American Academy of Family Physicians,iv
a PCMH is:
• Physician-led: Each patient has an ongoing relationship with a personal
physician who provides continuous and comprehensive care.
• Oriented to the whole person: The care team provides comprehensive
care, including acute care and chronic care at all stages of life.
• Integrated and coordinated: Care managers take steps to ensure that
patients receive all the care they need within the clinic and community.
• Focused on quality and safety: It uses continuous quality improvement
and evidence-based medicine to monitor and improve outcomes.
• Accessible: Clinics commit to enhancing patients’ access to care.
A growing body of research is providing evidence that PCMHs curtail overall
health care costs by reducing inpatient visits, emergency department use
and hospital readmissions.
The WeCare TLC Physician-Led Primary Care Medical Home
For more information about the PCMH model, read the National Committee
for Quality Assurance’s Latest Evidence: Benefits of the Patient-Centered
Medical Home or the National Committee for Quality Assurance’s Patient-
Centered Primary Care Collaborative’s The Patient Centered Medical
Home’s Impact on Cost and Quality: An Annual Update of the Evidence
2012/2013.
Study Proves the Value of
Employer-Based Medical
Homes
SAS Institute Inc., headquartered in
Cary, NC, has operated an on-site
health center for more than 30 years.
A new study by SAS and Duke University,
published in the July 2015 edition of The
American Journal of Managed Care,
makes a strong case for encouraging
employees to make the health center
their medical home.
The study divided SAS employees and
their dependents into three categories:
1. Major users – those who desig-
nated the SAS on-site clinic as their
medical home.
2. Casual users – those who identified
community medical providers as
their medical home, but used some
on-site clinic services at least once.
3. Nonusers.
Casual users had the highest health
plan costs of the three groups. Major
users who made the clinic their medical
home saved SAS $482 per year in
health care costs, when compared
to casual users. Most of the difference
($283) was for pharmaceutical costs.
future health care costs.
As for dependents, the difference was
even more dramatic. Dependents
who were casual users had the highest
claims costs, followed by nonusers.
Major users saved SAS $600 per year
in health care costs when compared
to casual users, and saved $330 a
year in claims costs when compared
to nonusers.ix

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The WeCare TLC PCMH relies on a team to deliver care. Instead of a
physician trying to accomplish everything in a 20-minute visit, a clinical
team – a physician, registered nurses, medical assistants and licensed
practical nurses – cares for the patient.
For example, the medical assistant checks in the patient, draws blood,
performs eye exams and other screenings. The physician designs
and supervises the treatment plan. The registered nurse educates
the patient in self-care and oversees care plan implementation. The
licensed practical nurse dispenses medication. All these interactions
are recorded in patients’ electronic health record, furthering care
coordination.
From a patient’s perspective, this means more time with the physician.
Freed up from routine tasks, WeCare TLC physicians spent at least 20
minutes with each patient; 40 minutes spent on the first visit. Patients
also enjoy the convenience of one-stop shopping. In one visit, patients
can receive a flu shot, get a test done, see their doctor and receive
needed medications.
Research shows that team-based care improves patient satisfaction
and confidence in their health providers.vii
One study of a patient-
centered medical home compared medical home patients with
those who visited a traditional clinic. PCHM patients reported higher
degrees of satisfaction across the board, including measures such as
the quality of their doctor-patient interactions; the degree of shared
decision-making; the coordination of care; their access to care and
the helpfulness of office staff.viii
Research also shows team-based care improves quality. First, everyone
from the physician to the medical assistant to the nurse brings his or
her unique clinical preparation to the patient. In addition, because
all providers work together, gaps in care are fewer.
WeCare TLC Financial Impact
**all savings are net of clinic costs
The Staffing Model
Physician: Sets the care plan; evaluates all the
data and information to make modifications
to the care plan; performs minor surgeries
and refers patients to specialists if needed.
Nurse practitioner: Cares for lower-risk patients
and provides urgent care.
Registered nurse: Talks to patients who have
symptoms; follows up on complicated test
results; coordinates pre- and post-surgical
care; educates patients on their conditions
and coaches patients in self-management.
RNs also serve as health coaches, manage the
care for individuals with complex conditions and
implement disease management programs.
Licensed practical nurse: Renews prescriptions
and follows up on abnormal (but not
complicated) test results.
Medical assistant: Schedules patients and
performs blood draws and simple examinations.
The Value of Team-Based Care
J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O
11 12 13 14
$0
$500
Unmanaged Health Care Cost Trend
* Per Employee Per Month
Results of setting up the WeCare TLC clinic and applying medical risk
management to a mid-sized employer's annual health care costs.
$1000
$1500
$2000
$2500
$737.43
PEPM*
when clinic opened
$685.72
PEPM*
at September 2014

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Making Care Convenient and Accessible
Typically, going to the doctor is inconvenient, stressful and expensive.
WeCare TLC strives to make it as easy as possible for employees to get
care by offering:
• A physician-led model. Although many patients will see a registered
nurse or nurse practitioner for some care, many want to have an ongoing
relationship with a personal physician.
• No co-pays. Even a small co-pay acts as a deterrent to care.
• Open appointments for walk-in visits. WeCare TLC purposefully schedules
open appointments each day to handle urgent and emergent care.
• A dispensary. The top reason patients first come to a clinic is to get their
medications filled.
• Convenient and flexible hours: Clinics are open late or on weekends,
and are designed to meet employee needs.
As a result of this approach, WeCare TLC has some of the highest employee
participation rates in the industry.
Measuring Metrics to Ensure Success
One of the hallmarks of a patient-centered medical home is an ongoing
commitment to quality improvement. WeCare TLC analyzes important
performance metrics such as:
• Patient satisfaction: Patients are surveyed on every visit.
• Generic utilization: Frequency of patients’ use of generic medications.
• Provider utilization: How often employees use providers at various licen-
sure levels: RN, NP or physician. It also assesses the types of clinical
services being used.
• Evidence-based practices: Providers’ charts are audited continuously
to ensure care is complete and follows evidence-based protocols.
• Referrals: Referrals to specialists must be timely and appropriate; none
should occur for routine office care.
• Follow-up care: Frequency that patients receive timely follow-up care.
0
25%
50%
75%
100%
Industry Average
WeCare TLC
Average Year One
WeCare TLC
Average Year Two
45%
65%
85%
Percentage of Employees Who Use On-site Clinics
Study Proves the Value
of Employer-Based
Medical Homes
On-site clinics tame health care cost
trends in two ways: one, by providing
similar services at much a lower cost
and two, by disrupting the existing
model of health care delivery.
When it comes to medications, tests
and treatments, WeCare TLC clinics
offer these services at a fraction of the
market cost. Its providers are salaried
and have no incentive to refer patients
to specialists or order unnecessary
tests. In fact, WeCare TLC clinics have
reduced referrals to specialists by 50
percent by providing needed care
within its primary care clinics.
Longer-term, the WeCare TLC model
improves employee health as many
workers who use the clinics previously
had no primary care provider. Through
care management, nurses also follow
employees when they receive care
outside the clinic to ensure high-
quality, coordinated and cost-effective
treatment. Through health coaching
programs, healthy employees stay well;
those with chronic conditions learn to
better take care of themselves, which
lowers future health care costs.
WeCare TLC’s results since inception
are promising:
50%
reduction in specialist referrals
85%
of prescriptions filled with generics
90%
of employees are satisfied with the
scope of services

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Why Medical Risk Management is the Key to Successful
On-site Clinic Operations
The patient-centered medical home serves as a platform to deliver primary
care services tailored to employees’ unique health risks. WeCare TLC seamlessly
pulls together employer health plan and on-site health clinic data, which it
then analyzes to identify health care cost savings and quality improvement
opportunities.
Using data from medical claims, employees’ health risk appraisal forms, the
electronic health record, pharmacy, lab and clinic costs, WeCare TLC’s clinical
analysis toolkit reports reveal where employee populations are getting healthier
and hidden opportunities for cost-savings.
WeCare TLC’s goal is to identify and manage current and potential employee
health issues in a way that mitigates short-term health costs. This helps employers
save money on health plan costs, while increasing employees’ long-term
health and productivity. This comprehensive approach is called “medical risk
management.”
Case Study: Healthier
Employees in Just One Year
When WeCare TLC opened a patient-
centered medical home to serve a
heavy equipment manufacturer in
Indiana, many of the company’s 720
employees were suffering from obesity
and overweight, high blood pressure
and uncontrolled diabetes.
In just one year, employee health
improved dramatically:
• 58 employees – or more than half
of the firm’s diabetic employees –
had their blood sugar under control.
• 181 employees – or 42 percent of
the overweight and obese workers
– lost weight.
• 64 employees improved their
management of high blood pressure.
Using widely accepted measures that
tie dollar values to health improve-
ments, WeCare TLC estimates the
manufacturer saved $404,325 in
long-term costs.x
• What are the untreated health needs
in my employee population, such
as diabetes and hypertension?
• What is the risk level of each
employee?
• How many employees are
overweight or tobacco users?
• When can generic medications
be used?
• Which community specialists and
hospitals should I include in my
plan design?
• Where am I seeing excessive
specialist utilization and should
I bring those services in-house?
Employers can find
answers to such
questions as:
Employers can
respond by taking
such actions as:
• Promoting the use of generic
medications at the on-site dispen-
sary.
• Changing clinic hours to ensure
maximum employee participation.
• Steering employees to certain
hospitals or specialists in exchange
for lower prices.
• Reaching out to individual patients
to boost enrollment in disease
management programs.
• Modifying clinic offerings to bring
more encounters in-house.

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Learn More:
Raegan Garber Le Douaron
Senior Vice President, Sales And Marketing
407-562-1212 ext. 958
raegan.garber@wecaretlc.com
WeCaretlcPopulation Health Management
“WeCare TLC brings a fresh concept to the practice of medicine. They have
the experience of operating clinics that are customized to the client and their
need. I believe strongly that WeCare TLC offers the experience, the neutrality,
the advocacy an employer needs and the expertise to manage your health care
clinic.”
Jim Rubottom, Vice President, Human Resources
The Knapheide Manufacturing Company
How Quickly Can New Clients Save Money?
Changing employee behavior and reversing health cost trends can take time. Actions and inactions from years before
can show up as medical emergencies many years later. That’s why WeCare TLC looks at health plan cost data for up to
three years prior to opening a clinic. After one year of opening a WeCare TLC medical home, the data team provides
employers with a rolling, month-over-month analysis of how their financial trend is changing.
Clients can expect in the first year to see health care cost inflation flatten, as employees increasingly use generic medica-
tions and get their primary care needs met at the clinic. In the second year, referrals will decline as employees use
specialists less frequently and their health improves as they start to more proactively manage their chronic conditions. In
the third year, employees’ chronic conditions improve, leading to reduced prescription medication and health care costs.

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GLOSSARY
Health Risk Appraisal: A systematic approach to collecting information from employees that identifies individual risk
factors, provides customized feedback and links employees with health coaches or disease managers. These appraisals
typically obtain information on demographic characteristics, lifestyle, personal medical history and family medical
history. In some cases, height, weight, blood pressure and cholesterol levels are included.
The Patient-Centered Medical Home: A model of organizing primary care delivery that encompasses five functions
and attributes:
1. Comprehensive care
2. Patient-centered
3. Coordinated care
4. Accessible service
5. Quality and service
Disease Management: Programs that use in-person or telephone coaching to identify gaps in care for common
chronic conditions and to improve patients’ medication compliance, self-care abilities and health knowledge.
Workplace Wellness: Programs that encourage employees to modify their risk factors for chronic disease through
behavior changes such as tobacco cessation, weight loss and regular screenings.
Care Management: Programs that use nurses to coordinate the care of individuals with serious, complex conditions.
Nurses identify the most cost-effective and clinically appropriate treatments and manage care across multiple sites.
Health Coaches: Work one-on-one with individuals to help them meet their self-identified health goals, such as losing
weight or managing pain. Nurse health coaches provide self-management support, serve as bridges between the
primary care providers and patients, and help patients navigate the health system.
End Notes
i
According to the National Association of Worksite Health Centers’ 2014 survey of 255 employers across 16 industries, employers’ top goals in implementing an on-site clinic
are to:
• Reduce medical costs;
• Improve worker health;
• Reduce absenteeism; and
• Improve employee engagement.
ii
Towers Watson. Employers Plan to Expand the Use of On-Site Clinics (press release). Arlington, VA: Towers Watson. (May 28, 2015). Available: https://www.towerswatson.com/
en-US/Insights/IC-Types/Survey-Research-Results/2014/05/full-report-towers-watson-nbgh-2013-2014-employer-survey-on-purchasing-value-in-health-care (Accessed October
1, 2015).
iii
OnSiteClinics: Business Coalitions Get in the Act. (Weblog) (September 5, 2013). Available: http://onsiteclinics.org/2013/09/05/business-coalitions-get-in-the-act/ (Accessed
October 1, 2015).
iv
Beth Umland. Employers Launch Worksite Clinics Despite ACA Uncertainty. (weblog entry) Mercer. (Aug. 27, 2015) Available: http://ushealthnews.mercer.com/article/444/
employers-launch-worksite-clinics-despite-aca-uncertainty#.ViFghqLtGSY (Accessed September 25, 2015).
v
Towers Watson. Employers Plan to Expand the Use of On-Site Clinics (press release).
Arlington, VA: Towers Watson. (May 28, 2015). Available: https://www.towerswatson.com/en-US/Insights/IC-Types/Survey-Research-Results/2014/05/full-report-towers-watson-
nbgh-2013-2014-employer-survey-on-purchasing-value-in-health-care (Accessed October 1, 2015).
vi
AAFP. The Patient-Centered Medical Home (website). Washington, DC. American Academy of Family Practice. Available: http://www.aafp.org/practice-management/
transformation/pcmh.html (Accessed Sept. 27, 2015).
vii
Jesmin, S., Thind, A. and Sarma, S. Does Team-based Primary Health Care Improve Patients’ Perception of Outcomes? Evidence from the 2007-08 Canadian Survey of
Experiences with Primary Health. Health Policy. 2012 Apr;105(1):71-83. doi: 10.1016/j.healthpol.2012.01.008. Epub 2012 Feb 10. (Accessed September 16, 2015).
viii
Robert J. Reid, Katie Coleman, Eric A. Johnson, Paul A. Fishman, Clarissa Hsu, Michael P. Soman, Claire E. Trescott, Michael Erikson and Eric B. Larson The Group Health
Medical Home At Year Two: Cost Savings, Higher Patient Satisfaction, And Less Burnout For Providers Health Affairs, 29, no.5 (2010):835-843 (Accessed September 16, 2015).
ix
Conover, Christopher, PhD., Brouwer, Rebecca Namenek, MS, Adcock, Gale, MSN, Olayeye, David, Shipway, John and Østbye, Truls, MS, PhD. Worksite Medical Home:
Health Services Use and Claims Cost. The American Journal of Managed Care. July 28, 2015. Available: http://www.ajmc.com/journals/issue/2015/2015-vol21-n7/Worksite-
Medical-Home-Health-Services-Use-and-Claim-Costs (Accessed September 27, 2015)
x
WeCare TLC estimates savings of $1,200 for every one point reduction in hemoglobin A1C value; for weight loss, a saving of $400 per year for every 1 percent reduction
in weight loss. For patients with blood pressure starting with a value of 140 or above, a savings of $95 for every 1 percent reduction in systolic blood pressure.