When Marshelle Grimes-Billings started work as a smock room attendant at a poultry processing plant in Decatur, Alabama, in 2021, health care was a luxury she couldn't afford.
At the time, Grimes-Billings weighed 330 pounds, and she carried with her a plastic bag full of pills including three medications for high blood pressure, three medications for diabetes, and various medications to manage gout flare-ups. Each trip to her physician -- a 45-minute drive from her home in Courtland, Alabama -- seemed to result in another prescription and tough decisions. "Do I pay the co-pay, or do I eat?" she recalls.
Grimes-Billings, now 53, is no longer diabetic, weighs 162 pounds, goes to the gym regularly and takes a single medication to help manage depression. She credits the free health care offered at an on-site clinic by her employer, Wayne-Sanderson Farms, with saving her life.
"The clinic gave me my life back," says Grimes-Billings, who regularly sees "Miss Patty" -- Patricia Catlin -- the nurse practitioner. "It gave me a quality life back."
While American employers have long offered health insurance, a growing number of organizations provide medical care as well. There are various models, but most on-site (or near-site) health centers are run by third-party vendors. They offer a combination of low- or no-cost in-person and virtual care; and while some people may be wary of receiving health care in the office, organizations that offer the option say employees appreciate the convenience of same-day appointments, on-site labs and consistent relationships with their providers.
It's a benefit strategy that is gaining traction across all industries, to attract and keep talent and to address common U.S. health care woes -- long wait times, short appointments, unnecessary and expensive ER visits -- that can lead to less healthy employees and weigh on the bottom line.
"This used to be a nice-to-have -- considered a perk for employers," says Beth Ratliff, chief operating officer at Premise Health, which runs 800 on- or near-site health centers for employers and unions in the United States. That's still true, but the growing demand is driven by employers' desire to control health care spending -- without sacrificing high quality care, she says.
Last year, the average premium for an employer-insured individual was $9,000, and for a family, $25,572; those rates are projected to increase 8% this year and 9% next year, according to Business Group on Health, a nonprofit focused on health care and workplace strategy.
"It's all about access. It's all about costs," says Larry Boress, executive director of the National Association of Workplace Health Care (NAWHC).
Boress notes that employers are also looking to improve the quality and experience of medical care and enhance productivity through on-site clinics.
"For workers who are low-income or don't have good access or just need to see a doctor, it's really the most treasured benefit that they're having now," Boress says.
The Business Group on Health recently found that 48% of surveyed employers offer an on-site health center. Some employers seem to be doubling down on the strategy. A recent Alliant-NAWHC survey of organizations that have work site health centers showed 28% of those companies plan to add more, while 54% intend to offer additional health services at existing clinics.
More than half of those employers reported more than a 200% return on investment from their clinics; a quarter reported a more than 300% return on investment. Companies like Marathon Health and Premise Health tout studies that show the clinics pay off -- sometimes even in the first year -- by driving down expensive, often unnecessary trips to the emergency room or urgent care clinics. Compensation to these providers is often tied to these improved outcomes.
The success of an on-site clinic is hardly guaranteed. There's an up-front investment that can only be recouped with a large and engaged employee base. For that reason, near-site centers, which are shared by employers, are increasingly popular.
Efforts can be wasted when there's not sufficient awareness or when trust between employees and employers is lacking. Law also prevents people with health savings accounts from getting free primary care in work site clinics, a policy some employers are lobbying to change.
Removing barriers to care was the main goal when Wayne-Sanderson Farms brought in Marathon Health to run an on-site wellness center, says Christy Freeman, director of benefits.
Many of the company's 26,000 employees live in rural areas, don't understand or trust the health system, or simply don't have the resources or time to prioritize health needs.
"Making things easy, making things affordable, putting that care right there at their fingertips ... is what we want to do," Freeman says.
In cases where employees require specialist care, companies like Marathon Health typically provide "care navigation services" -- identifying a high-value provider, handling insurance paperwork, managing follow-ups, etc.
When Sterne Kessler, a law firm in Washington, D.C., added a health clinic staffed by CloseKnit Health as part of an employee-friendly office redesign in 2022, the aims and results were similar.
"Working at a law firm isn't easy. You have a lot of stress and a lot of hours," Chief Operating Officer Rob Burger says. "I saw people neglecting themselves."
Burger's goal was to remove the friction -- the inconvenience and competing priorities -- that kept the firm's 500 employees from going to the doctor.
Despite some initial skepticism, the in-office health center has been a popular and impactful perk: It caught one employee's urgent heart condition, and 85 of the employees have been so pleased with their experience that they've designated the firm's nurse practitioner, Kristie Quarles Washington, as their primary care provider.
Burger is confident the office clinic has already saved lives: "It's exceeded our expectations," he says.
Charter Communications, which in recent years opened health centers operated by Marathon Health, facilitated more than 10,000 appointments at three of its corporate campuses. The benefit also helps the company control spending on health care.
"People get what they need," says Paul Marchand, executive vice president and chief human resources officer. "They get it on time. They get it in a convenient manner, and they walk out saying, 'Wow, that was easy.'"
One employee told Marchand he hadn't seen a doctor in five years but when presented with the convenient opportunity at work, he'd signed up right away.
The company is planning a possible fourth on-site clinic.