On-Site Clinic Provider IMWell Grows Client Base in Region

Jeff Fields credits IMWell Health LLC with saving his life.

It was a standard visit two years ago, he said, just a checkup on a sinus infection. But the nurse practitioner suggested he check his PSA level.

"I initially balked at the notion," he said. "I felt fine. The practitioner urged I get the test done, so I gave in."

The test showed elevated PSA, which led to a prostate exam, which showed the presence of prostate cancer. Fields had the cancer removed and has since fully recovered - all because an IMWell nurse knew Fields' age - 56 at the time - and health records.

Later, a doctor told Fields that he might have died within a year if he hadn't had the cancer removed.

Like other patients at IMWell clinics, Fields works for a big, self-insured employer that contracts with the Fort Smith company to provide routine medical services for employees. Fields is a public information assistant for the city of Hot Springs.

Since its genesis eight years ago, IMWell has opened five clinics in Fort Smith and others in Hot Springs, Little Rock, Fayetteville and Tulsa. CEO Dan Parker said the company's 11th clinic will open in Oklahoma City this summer.

Patients for the 11 clinics come from about 30 client companies ranging from big manufacturers like Baldor Electric Co., O.K. Industries Inc. and Whirlpool Corp. to the local governments of Hot Springs, Fort Smith and Washington County.

IMWell also has four major clients in Tulsa: the River Spirit Casino, Melton Truck Lines Inc., Ameristar Fence Products Inc. and Tulsa's Fraternal Order of Police. Most recently, the company signed on the government of Oklahoma County, the county that includes Oklahoma City.

Each clinic has a doctor or an advanced-practice nurse. IMWell employs 50 workers total, including 45 full time and five part time.

The company started in 2004 with Dr. Catherine Womack, an internal medicine physician with an active practice in Fort Smith. Parker said some larger employers took notice of Womack's ability to manage people with chronic diseases.

"They encouraged her to go into a private business to serve employees of these large companies," Parker said. So she did.

Parker himself took note of Womack shortly after. He already had experience in self-funded health care; he had been CEO of HealthScope Benefits Inc. of Little Rock, a third-party administrator.

"I knew that ... convenient and low-cost access to primary care is the true solution to managing total health care costs," he said. "And I knew that Dr. Womack had something working quite well."

In 2006, Parker joined Womack as a business partner. He said he was "determined that we could reach more people by expanding that business to a full-blown family practice type of service."

Early clients signed on quickly, Parker said, and soon IMWell was growing into a network of clinics. Womack stayed with the company in Fort Smith, and Parker became CEO.

"With these clinics, we've been able to manage chronic diseases more cost effectively and reduce emergency room encounters, and we are able to increase generic drug utilization," Parker said.

Chad Collins, who works in business development for IMWell, said the differences between client costs for an IMWell visit versus a visit to the emergency room were significant.

"When a patient goes to the ER for primary care like a sore throat or a sprained ankle, it could cost ... $300 to $350 per visit," he said. "The typical cost here is $140. We keep people out of the ER so they can go to the ER for something like a car accident or other large things, and for those acute care issues that are not as critical or urgent, they can come here."

Parker said some client companies have enjoyed stable health care costs for five years, and IMWell claims to lower ER use among client employees by 20 percent and to increase the use of cheaper generic drugs by 7 to 8 percent.

"The cost differential when measuring overall cost for treatment of diabetes and hypertension, we tend to be about 50 percent less on average," Parker said.

Erin Holleman, an advanced-practice nurse in the company's Little Rock clinic, said patients benefit financially as well.

"When patients come to us, they don't have a co-pay for anything," Holleman said, "especially on minor procedures."

Holleman said she can easily treat ailments like cysts that otherwise would require a patient to go to a dermatologist to be referred to a specialist, enduring co-pays - and costs to their employers - for both.  

"We've enjoyed zero co-pay for our employees," said Vicki Stauder, human resources specialist for the city of Hot Springs. "They're more likely to go to the doctor versus coming up with the money out of pocket to go."

The IMWell model gives companies a choice between multi-employer and on-site clinics. The former option requires no startup cost and gives employees access to a clinic a short distance from the employer's headquarters. An on-site clinic is available to companies with more than 800 workers, is developed with fixed fees and is installed directly into a company's facility.

The nearby and immediate availability of the clinics save companies big bills from ERs, brand-name drug prescriptions and trips between various specialty doctors.

Patients are allowed access to anything from treatment for minor injuries to diagnostic testing to vaccination.

IMWell's revenue should exceed $5 million this year, Parker said, a 25 percent increase over last year. He said the clinics have given the big companies productivity boosts and improved quality of life for employees.

"I believe that the employers depend upon their workforce to be there daily, and not just that, but to be there in good health," he said. "They feel the benefit of having a clinic available to employees to be seen ... for acute care issues, so they can be on their game while at work."

 

What's the Secret?

IMWell's success can mainly be attributed to the fact that it's one of the few players in its game.

"There's no other companies like us headquartered in Arkansas," Parker said. "There's a limited amount of activity from other companies in the state, but it is indeed very limited."

The concept of on-site clinics is more common on campuses with more than 5,000 employees, Parker said. Most of the time, he added, IMWell finds itself having to explain its product to new clients - they've never heard of it before.

"We're becoming what most companies consider a best-in-class benefit for employees," he said. "So when we are going out to sell this concept, it is indeed new to most employers."

Parker said that rarity is what makes IMWell so desirable.

"There are very few products on the market today that can both help manage health care costs and improve the health and productivity of workers," Parker said. "More and more companies recognize they can't depend upon the government for health reform to control costs."

The singularity of IMWell's service allowed it to thrive through the recession, bolstered by luck: None of its clients folded during the downturn.

"We did see a downturn in employment," Parker said. "That had an adverse effect on income. We were able to manage through that and grow the business through that period of time."

Parker said IMWell isn't done expanding yet, either.

"We want to double the size of the business in the next two years," he said. "We'll see further growth in Arkansas, Oklahoma and Texas - those are key opportunities for us."

Doubling the company's size will take initiatives in sales, account management and implementation, Parker said.

"We'll certainly evaluate other states for large employers, in particular ones who desire an on-site presence."