Self-Funded Employer Finds Onsite Health Clinic a Powerful Solution for Improving Employee Wellness and Controlling Cost

Headquartered in Houston, Boxer Property Management has approximately 750 employees in several different markets across the United States. After facing challenges managing their healthcare spend with a fully-funded insurance program, the company needed a path that provided more control by mitigating healthcare risks and reaping the benefits of a population engaged in their own wellness.

Boxer’s Chief Human Resources Officer Betty Jean Larson says one of the motivations for switching to a self-funded model was also so that Boxer “could try to reduce our spend with the insured and have more insights into what’s going on with our population.

Self-funded plans work best when workers take advantage of primary and chronic disease management services. When they don’t, the organization may incur higher medical expenses for health conditions that could have been either prevented or treated in less intensive settings than an emergency room or hospital. “The median age of our employees is probably 45 to 50 years old,” says Larson. “When people don't receive preventive health care, they may develop diabetes or high blood pressure, but don't know until something horrible happens.”  

People fail to seek preventive services for a variety of reasons. Perhaps they don’t have a primary health care provider, consistent income, or health insurance. It also may be difficult for employees to take time away from work and travel to a physician’s office. Unfortunately, when employees fail to seek preventive care, they often need to miss more work, resulting in lost productivity.   

To maximize the benefits of self-funding, Boxer needed a dependable way to improve access to and use of primary care and chronic disease management services. Like an increasing number of companies that use self-funded insurance models, Boxer turned to a proven, effective employer health solution: an employer onsite health clinic. But they couldn’t work with just any onsite clinic provider – they needed a solution that was right-sized, and most options were either too much or too little.

Too many companies were cost-prohibitive or unwilling to tailor their out-of-the-box offering to suit a smaller employer. In contrast, others offered only telehealth — a great tool for support but one that cannot, alone, provide the full range of care, such as labs, exams, and other interactions that require an in-person touch.

Enter Hamilton Health Box. Their hybrid delivery model opened the door to possibilities – by partnering with employers to deliver the right mix of services, they fill care voids cost-effectively with a high-touch, hybrid model that pairs the best parts of in-person care with tech-enabled virtual medicine.  

Additionally, Hamilton Health Box could efficiently serve Boxer’s smaller population by distributing labor across their clients to keep Boxer’s cost structure low while at the same time providing consistent accessibility and continuity of care.

For Boxer, the decision was clear: Hamilton Health Box’s unique onsite primary care, combined with telehealth options accessible from anywhere, provided a clear path for increased access to preventive services.

HHB’s model offers a complete primary care experience at the workplace by using physicians, nurse practitioners, physician’s assistants, and other highly trained medical professionals to provide all the services offered in a doctor’s office, such as in-clinic blood draws, annual wellness exams, biometric screenings, standard X-rays and more. At the same time, employees and their families have access to virtual urgent care 24/7/365. 

In the company’s Houston office, Boxer dedicated a space that was designed according to the specifications HHB provided. Like any clinic, the office includes examination and waiting rooms outfitted with the technology necessary to deliver primary care, as well as medical staff who are present during office hours.

Should employees or their family members fall ill during the weekend or “off” hours, they have immediate access to on-call physicians and nurses, which Larson notes reduces the need for costly visits to urgent care or a hospital emergency department. HHB also sends mobile units to Boxer’s smaller sites throughout Houston on a monthly basis.

Larson believes that the onsite clinic not only provides easy access but also leads to quicker treatment, which in turn, means less time missed at work. If a Boxer employee has a sinus infection, for example, they can receive a diagnosis and obtain a prescription so that treatment can start immediately. Furthermore, a pharmacy delivery service will send a worker's prescriptions to the onsite clinic, so employees don’t need to leave work to pick up their prescriptions.

Not only does HHB’s program increase convenient access to care for Boxer’s employees, but it increases transparency in the communication with Boxer’s human resources (HR) department. Larson notes that the clinic is proactive in letting her know when staffing or protocols might have changed. While adhering to HIPAA regulations and preserving patient confidentiality, the clinic will also communicate with HR about patients. “Clinic staff let us know when an employee was seen, if they were sent home, and when they are able to come back to work,” Larson says. “We don't have to bother sick employees for that information, and they don’t have to contact us when they aren’t feeling well. It saves everyone a lot of aggravation.” 

HHB has proven to be a tremendous asset to Boxer’s employees and, in some cases, may have made the difference between life and death. During a meeting, a manager noticed that one of her employees seemed “off” and was complaining of a serious headache. The manager called Larson, who suggested that the employee immediately visit the onsite clinic.  

After examining the employee, the onsite clinic provider sent her to the hospital immediately to be evaluated for a stroke. That was exactly what was happening.

"She might have gotten in the car and driven home. She might have gotten much worse overnight. She might have died. But because her stroke was caught so early, she's back at work and very productive,” says Larson.

This example is one of many and illustrates just how valuable onsite care can be — how can you put a cost on a human life?  

At the same time, it also points to the kind of hard-to-quantify metrics that include potential savings from a catastrophic event. For Boxer, it’s often a matter of weighing known costs against “what could have been.” While it’s difficult to say with certainty that employees who have access to HHB services will use those instead of going to the emergency room, research showed that each visit managed by HHB saves an average of $500, which for Boxer amounted to $72,000 in savings in year one and $87,000 in year two.  

Boxer can also see the results of working with HHB reflected in their “Per Member Per Month (PMPM) Healthcare Spend”: From 2019 to 2022, they reduced this amount by $124 per member each month — multiplied across their members, this kind of savings adds up.

HHB’s onsite clinic has been particularly effective for Boxer’s workers’ comp cases. In addition to providing pre-employment physicals and drug screens, HHB handles first aid for work-related injuries. In such cases, there is often urgency to the situation, and an onsite clinic can see an employee immediately. But what really differentiates HHB’s approach to these cases is the way it tailors its response.

Because of this, they’re going to give more appropriate restrictions so that people can return to work rather than sitting at home collecting only 60 percent of their pay.”

These are just a few ways that HHB supports Boxer in encouraging overall wellness and controlling healthcare costs. The numbers alone tell the story of how access to onsite primary care is driving employee engagement in their own health. In just one year, the number of Boxer’s employees participating actively in healthcare services at HHB went from 47% to 75%. And of those, the total population with critical chronic disease management needs jumped from 76% to 95%.

“I'm actually surprised that more companies aren't doing this by now,” says Larson. “In the past five years, I don't think we've raised our cost to the employees for their insurance at all.” It’s a win-win for everyone involved. “If we can catch an illness early, then people can manage it, and we have a better, healthier workforce, and a more motivated workforce, a more engaged workforce, because they feel well.” And that’s a value realized every day.