There are a wide range of options for both employers and employees (to say nothing of dependents and retirees) when it comes to employee health management (EHM). They can be arrayed along a “convenience continuum” ranging from the inconvenience of one site location and limited hours — to many sites and convenient hours – to whenever and wherever the individual employee wants to get them. The placement of EHM options along this continuum will have a great deal to do with how widespread employee participation will be, and thereby how successful EHM investments will be.

Traditional hospital-based programs, such as the U.S. Preventive Medicine “Centers for Preventive Medicine” model, which limits the number of hospitals to which it will offer a “franchise” in a given market, or traditional occupational medicine practices, tend to occupy the low end of convenience, often operating only one location. They can move toward the middle by at least offering services at multiple locations, and broadening their hours beyond traditional 9-5 weekdays, but this only improves their convenience a little.

More toward the mid-point of the convenience continuum are the growing number of “retail clinics” heading toward 1000 or more across the U.S. These are more convenient because of longer hours, short waits, as well as lower prices, compared to traditional providers, and offer convenient parking, as well as something useful to do while waiting when this is unavoidable. Many offer waiting patients a pager they can use while shopping elsewhere in the superstore, supermarket or pharmacy where they are located, for example.

Retail clinics — particularly those close to the RediClinic model that combines “Stay Well” services, such as smoking cessation, preventive screenings and immunizations, to the usual retail clinic array of “Get Well” services – are a good example. A recent study sponsored by the Centers for Disease Control and Prevention, conducted by the New England Complex Systems Institute, reported that retail clinics are “…particularly well-suited to the delivery of preventive care, (which) can produce superior returns in terms of employee health improvements and cost savings.” [“Houston Employers Hear New Research That Supports the Case for Retail Clinics” Resident and Staff Oct 29, 2007]

RediClinics have the added advantage of their own proprietary electronic medical records, that can be used to identify patients that are due for a particular screening, immunization, or preventive service visit. This also enables them to coordinate with their patients’ personal physicians, when such physicians choose to work with the clinics on health management efforts. Some hospitals offer similar convenience when they coordinate and participate in primary physicians’ EHM efforts at practices that are affiliated with or owned by the hospitals.

Further up the convenience continuum are worksite medical clinics, which can offer reactive sickness care as well as proactive health management services to employees, and also dependents and retirees where permitted. These offer greater “place” convenience, and are often free to employees, at least. They are usually not open much before or after working hours, so are limited in “time” convenience, though they may offer an even wider range of EHM services than do most retail clinics. Of course, retail clinics become onsite medical clinics for employees of the stores that sponsor or host them.

Still more convenient are EHM programs — offered by traditional providers, employers, insurers, or specialized suppliers – that offer phone coaching or remote monitoring to participants. Such EHM elements can be offered at times and places participants choose, rather than being limited to clinic locations and hours. Of course, not all such programs offer 24/7 services, since few people tend to opt for late night/early morning communications, and staffing at such hours is likely to be more difficult and expensive than at more commonly used day and evening hours.

At what may be the peak level of the convenience continuum are EHM communications that are provided via e-mail or post, where participants can open messages at their own convenience, wherever they have access to the Internet, or where they get their mail. A similar level of anytime/many places convenience is available with EHM programs that rely on website visits by participants, and anytime/anyplace convenience can be offered through wireless communications, via text messaging, i-Pod podcasts, etc.

While we are far short of a systematic research foundation that has analyzed all kinds of EHM processes and discovered as well as reported which are most effective and efficient, what we do know, at least, is that the greater the level of convenience offered to participants, the more likely they are to enroll, cooperate in, and complete EHM programs. And since these programs are responsible for the behavior and health status changes that deliver desired reductions in the incidence and prevalence of disease, sickness care costs, and impairment in productivity and performance, the more convenient the better.