Department of Research & Evaluation News

A decade ago, Kaiser Permanente in Southern California sought to improve access to primary care by expanding patient services outside of hospitals and medical offices. They considered the possibility of offering health care at an actual worksite, just like Kaiser Permanente founders Sidney Garfield, MD, and Henry J. Kaiser did early in the development of what is now the nation’s largest integrated health system.

At the same time, California Steel Industries in Fontana, California, put out a request for proposals to build a primary care clinic at their worksite. Kaiser Permanente won the contract, and it changed health care significantly for many of the company’s 1,000 employees.

A research article published today found that in the seven years since the clinic opened, primary care visits among employees and their family members insured by Kaiser Permanente increased, and the rate of urgent care and emergency department visits decreased.

The future of health care

“This is a model for the future,” said Paul M. Minardi, MD, senior author on the research article and the medical director of Business Management for Southern California Permanente Medical Group. “With this model, we can bring primary care directly to people so we can provide timely preventive care, and avoid long-term implications of chronic conditions and unmanaged health needs.”

The study on the pilot project was published in the Journal of Evaluation in Clinical Practice. It compared California Steel employees who were Kaiser Permanente members with a control group of Kaiser Permanente members who lived in the same area, but did not work at California Steel.

Significant increase in primary care visits

The study found that:  

• California Steel employees and their families had an increase in primary care visits of 43 percent, while the control group had an increase of 4 percent.
• California Steel employees and their families had a decrease in urgent care visits of 43 percent, while the control group had a decrease of 5 percent.
• California Steel employees and their families had a decrease in emergency room visits by 4 percent, while the control group had an increase of 8 percent.
• While the rate of primary care visits increased for the California Steel employees by 96 percent, it only increased by 15 percent for their dependents.

“This research explores what happens when primary care is easily available,” said lead author David Glass, PhD, a Kaiser Permanente research scientist at the Department of Research & Evaluation in Southern California. “Although this was one small pilot, we learned a lot from it and were gratified to see decreases in urgent care and emergency room visits.”

While the rate of primary-care visits increased for the California Steel employees by 96 percent from the pre- to post-intervention period, it only increased by 15 percent for their dependents.

Glass also noted that due to the employees’ higher rate of primary care visits and a limited number of costly inpatient stays, there were no cost savings overall from the project. If researchers looked at dependents alone, though, they found that there was a cost savings.

“There has been a widespread belief that if patients had more access to primary care that costs would go down because there would be fewer high-cost visits to urgent care and emergency departments,” said Glass. “But the reality is much more complicated than that.”

The researchers hope to explore what happens when they work with larger employers.

Becoming health care partners

At the same time Kaiser Permanente leaders in Southern California began looking at ways to create new health care opportunities, California Steel wanted to better manage the health care costs of their employees, reduce absenteeism and allow employees to manage their health care while at work.

The clinic construction began in 2009. It was a slow time in the steel industry, so instead of laying off workers, California Steel had them build the health care center. The worksite clinic opened in 2010. It was not the first time Kaiser Permanente was part of building something at that Fontana location. California Steel is on the site of the former Kaiser Steel Mill, where the first Kaiser Permanente hospital in Southern California was built in 1942.

The California Steel Kaiser Permanente members received their care at the clinic for free (no co-pays), and received same-day appointments. California Steel employees who were not Kaiser Permanente members also could receive health care at the clinic.

In providing health care to California Steel workers, Kaiser Permanente became a health care partner and helped its Fontana campus become smoke free, remove unhealthy foods from vending machines, offer healthier options in the cafeteria and tackle obesity with a range of programs.

More on-site clinics planned

“Kaiser Permanente saw its insured portion of the workers grow from 40 percent to 65 percent,” said Dr. Minardi, “and virtually every new employee signs on with Kaiser Permanente.”

The pilot project at California Steel will continue at least five more years.

Kaiser Permanente is now beginning a new pilot project with the employees of the county of San Diego, Dr. Minardi noted. They are seeking other large employers to work with as well.

“The intent is for us to bring care forward, create higher quality care, and in the end that will decrease the cost trend over the long term,” said Dr. Minardi. “And that will accrue back to the employer group.”

When Kaiser and Dr. Garfield opened the 50-bed hospital at the Kaiser Steel Mill, they offered something revolutionary for the time: a pre-paid health care plan to provide affordable, quality health care. The revolution into providing affordable, quality health care continues, and sometimes finds its way back to its roots, literally.