Healthcare Conversations: Dr. Matt Eastman and OnSite Care

About this episode:

In this special episode of UB Insider, Utah Business’ Pat Parkinson talks to OnSite Care’s Matt Eastman about how clinics on work sites benefit the overall health of companies’ employees and their families, and why having easy access to medical care helps promote preventative care. Subscribe or download this episode via iTunes and Stitcher.


Pat Parkinson: Hey, greetings everyone. Pat Parkinson here and I’m thrilled to be podcasting today from the Grand America Hotel in beautiful downtown Salt Lake City. We’re having a great conference today about the future of healthcare and I’ve got to tell you man, I’m having a tough time getting through these interviews because these people are blowing my mind. They’re bringing all kinds of innovative tools and tricks and new trends in healthcare that I didn’t know existed. And I’m frankly having a hard time keeping up. I don’t think this guest is going to be any exception.

I’m sitting here today with Matt Eastman, Dr. Matt Eastman of OnSite Care. And Matt’s got a very interesting story to tell. It’s a story about something that you might not know exists. And Matt, what’s the proper term? Or what do you call the facility that you work in and manage?

Dr. Matt Eastman: It’s an onsite clinic, basically. It’s a full scope family medicine clinic that’s at an employer’s facility.

Pat Parkinson: And is that a new development, clinics like that? Onsite at workplaces?

Dr. Matt Eastman: I wouldn’t say new. I work for a company called OnSite Care clinics. And Dr. Donna Milavetz founded that company in 2007. Prior to that, you would find some workplace clinics around, but frequently they were workplace clinics that were kind of almost urgent care clinics. Mostly geared towards runny noses, coughs and colds, minor injuries, that type of thing. But the idea of a full scope primary care clinic at an employer’s facility I think is quite a new concept.

Pat Parkinson: Now the former that you’re describing, the former situation, the original kind of situation it seems like that was more suited or more geared towards incidents that occurred on the job or at the workplace. As opposed to Donna educating me about, you, any employee can bring any health concern to you in the clinic as if it’s their normal care.

Dr. Matt Eastman: Right. So we’ve had to, I guess try to educate the employees and family members that we are a full scope primary care clinic. So I’m a family physician. I do full scope family medicine. That includes acute care management: colds, runny noses, injuries, that type of thing. But it also includes identifying and managing chronic illness. Things like diabetes, high blood pressure, depression. So the idea of having a full scope primary care clinic at an employer’s work site solves a number of problems. So many problems.

Pat Parkinson: Like what?

Dr. Matt Eastman: Well one of the reasons, one of the main reasons that patients don’t engage with the healthcare system is something that everybody is familiar with. When you get sick, when you have a chronic condition, you have high blood pressure or things like that and you decide that you want to go to the doctor, what do you typically do? You call and make an appointment, right? Which means that you have to arrange time off of work. Which means you’re usually talking about at least a half a day off of work.

You might not find that the doctor has availability to see you when it’s convenient for you. I think we all know these types of problems. So the way to manage or fix that type of problem is to actually take the clinic to the employee. So imagine that you need to see the doctor to manage your blood pressure, to manage your depression, your diabetes, or you think you have a sinus infection. You call the clinic and they say, we have an appointment availability in two hours. And for you, instead of taking a half day off of work and going somewhere, it’s a five-minute walk down to the clinic.

Pat Parkinson: That’s awesome.

Dr. Matt Eastman: You spend your 30 minutes in the clinic and then go back to work.

Pat Parkinson: Why does the employer, why does the company where you have the clinic, not the company, you don’t work for that company, mind you. You work for OnSite Care. Why does the company where your OnSite Care facility is located have you there? I guess from a, not from a rank and file perspective. I get that. That’s great. What about the management? What’s the incentive there?

Dr. Matt Eastman: The answer to that question I think is multifactorial. The CEO of the company that my clinic is at, Merit Medical Systems is Fred Lampropoulos. He’s always had a little bit of an altruistic view of how he should take care of the people who work for him. So part of the reason that the clinic is there in this particular instance is because he wanted to offer a real, important service. He recognized that many of his employees didn’t have access to good healthcare. And he recognized through various things that happened to him that the best way to do that was to bring the healthcare to them. So there’s an altruistic aspect there.

Pat Parkinson: Do you respect him for that?

Dr. Matt Eastman: Oh, for sure.

Pat Parkinson: Is that a good vision for a boss to have?

Dr. Matt Eastman: Absolutely. And his employees respect him for that.

Pat Parkinson: They do?

Dr. Matt Eastman: Absolutely.

Pat Parkinson: They like him because of that?

Dr. Matt Eastman: He tells me that he gets stopped by people on a daily basis thanking him for bringing the clinic to the work site.

Pat Parkinson: That’s cool, man. That must make you feel good too, obviously.

Dr. Matt Eastman: Absolutely. So that’s an aspect of why the clinic is there. There’s also an aspect of why the clinic is there of him recognizing that healthcare benefits are a way that companies are beginning to differentiate themselves. They’re a way that companies are beginning to attract and retain talent, is by offering robust healthcare benefit packages.

Pat Parkinson: Awesome.

Dr. Matt Eastman: Right. So I think that was very forward thinking by them as well. That in an effort to attract and retain good talent, that one of the ways that he could really do that was to make healthcare as accessible and affordable as possible for them. And he saw the clinic in that light as well.

Pat Parkinson: That’s great. I’m also here with my co-podcaster Dan Bischoff. And Dan’s going to kind of jump in if he ever kind of feels compelled to do so. He might have some questions.

Dan Bischoff: A couple questions. I don’t remember if you asked Donna this earlier, because we kind of talked about this a little bit too. Is there a size of company that is the best fit for this? This is not going to be…not every company can afford to have onsite medical service of their employees.

Dr. Matt Eastman: Yeah. And that’s an important question. Merit Medical Systems employs about, close to 1,500 people in the South Jordan area.

Dan Bischoff: I’m from Wyoming. That’s like a small town in Wyoming.

Dr. Matt Eastman: It basically is a small town. They have a cafeteria and a clinic and everything. So the clinic is available for employees, spouses and dependent kids up to the age of 26 years old. So you’re talking about close to about 3,500 lives.

Pat Parkinson: And most of these folks, obviously, are insured by the Merit insurance program I’d guess.

Dr. Matt Eastman: Yes. Most of them are. That doesn’t differentiate whether or not they can use the clinic. But you’re exactly right. A small employer who had maybe 100 employees, if you include spouses and family members in that you’re getting to maybe 350, 400 people. It would be difficult from a cost perspective for a company like that to justify this kind of expense. But OnSite has created clinics for employers that have multiple work sites.

So OnSite runs a clinic for Flying J Management which includes Maverik and all of their employees. So obviously that’s a place that has work sites spread around in multiple areas around the valley and they’ve been able to make it work. One of the primary benefits of an onsite clinic is convenience. And if you develop those kind of co-op’d systems, you lose a little bit of that convenience but I think you could probably make up for it in other ways.

Pat Parkinson: And you save money.

Dr. Matt Eastman: Absolutely. So one of the reports that we look at every month with Merit is we look at how much money would the people have spent who come to our clinic. How much money would they have spent if they had received the same services in the community? And that monthly report is continually in the negative for Merit by tens of thousands of dollars.

Pat Parkinson: Wow. Which is very positive.

Dr. Matt Eastman: Absolutely. Absolutely.

Dan Bischoff: I just thought, what was the panel you and Donna were on? Donna wanted to get into what you guys were talking a little bit more. Maybe we should kind of switch gears a little bit.

Pat Parkinson: Yeah, definitely. We’re going to get into healthcare consumerism. Pretty cool term there. That’s the panel that Dr. Eastman spoke on today or served on today with Donna. And Matt, maybe we can talk at the end of the podcast, I think it would really interest folks to kind of get back to kind of your past life as a physician. And maybe some compare and contrast with what you’re doing today. But I think Dan’s right. We’re here at a business conference. We’re here at a Utah Business conference and that kind of says something about the audience and maybe why you’re here. So why don’t you tell us a little bit about what healthcare consumerism is and try to make it interesting for our audience, if you would.

Dr. Matt Eastman: So healthcare consumerism is really just the idea that healthcare is a consumable commodity. And the better informed the consumer is, the better decisions they can make. And it’s primarily around the idea of cost. And the way it is much of the time, the way it frequently has been, is that patients or consumers have no idea about the cost of the services that they’re consuming until after they’ve consumed them. Providers, while they’re helping make decisions about what healthcare resources they should consume have no idea how much the cost of those services, goods, whatever is.

Pat Parkinson: Everybody’s in the dark.

Dr. Matt Eastman: Absolutely. So it’s a lot like if you had decided to buy a car. You went to a car dealership. You were starting to interface with the car salesman and eventually you asked, how much is this car going to cost? And the car salesman said, you know what, I really don’t know. Let’s just figure out what you need. And then once we’ve made that decision, then we’ll figure out how much the car is going to cost and we’ll send you a bill later.

Or if you went to a restaurant and there were no prices on the menu. And the server came to take your order and you asked how much is this meal going to cost? And she said I have no idea. But once you’ve eaten the food, then we’re going to turn around and make a bill and send it to you. You wouldn’t consume any service in that way if you didn’t know what you were getting and how much it was going to cost you before. You wouldn’t even do it. But that’s the situation that we encounter in healthcare almost every day.

Pat Parkinson: And again, to reiterate, the doctors are in the same boat. That’s part of Donna’s frustration.

Dr. Matt Eastman: That’s right. So in a typical scenario and in my former scenario, let’s say somebody came in and they were talking to me about their back pain. And the back pain had been persistent and both they and I felt like maybe it was time to get an imaging study, something like an MRI. Maybe the person would say to me, I don’t have health insurance. How much is that going to cost me? My answer to that question would honestly have been I don’t know.

Or let’s say somebody has health insurance and they want an MRI. And I would say, you know what, I really don’t think you really need an MRI, that’s a pretty expensive study. They would say, I don’t care. I’m not the one paying for it. I want the MRI. So when patients don’t know how much somethings costs, how much something costs, they tend to consume more of it. Right? Because they don’t know how much it costs. They’re not the one paying for it. It’s no skin off their back. They just want what they want.

Pat Parkinson: And for the uninsured example, they just don’t get the service?

Dr. Matt Eastman: Absolutely. Or they get the service and then they get a bill which they can’t pay. And then the person who provided that service doesn’t get paid.

Pat Parkinson: That’s fascinating stuff.

Dan Bischoff: Yeah. That happens all the time.

Dr. Matt Eastman: It happens so much.

Dan Bischoff: When you have a baby. When you just go to get a shot, to get immunizations, whatever it is. Just a quick check up, that happens all the time.

Pat Parkinson: It’s the unusual nature of healthcare. It’s a very unusual product isn’t it, healthcare?

Dr. Matt Eastman: It’s a very unusual product.

Dan Bischoff: But you also have the insurance that you think will pay for it, and then they won’t pay or part of it and you don’t know what they’re going to pay for. Is that part of it?

Dr. Matt Eastman: That’s absolutely right. And the insurance, sort of landscape is a little bit of a quagmire that’s difficult for patient’s themselves to navigate. If you try to get into your insurance policy to figure out what your copay is, what you’re responsible for, what your insurance will cover, you’re talking about pages and pages and pages of small print. That’s often very difficult to decipher.

Pat Parkinson: Is that by design? Is it purposeful?

Dr. Matt Eastman: I don’t know that it’s purposeful. But the effect is that patient’s feel like they can’t understand it. So they expect the doctor’s office to be able to understand it and decipher it. But I as the provider don’t have that cost information either.

Pat Parkinson: And that’s not really your, I know you wouldn’t say it this way, but that’s not really your responsibility either, is it?

Dr. Matt Eastman: Well that’s how I felt before. But in my current situation I don’t feel that way. Because a lot of the patients that I work with at Merit Medical Systems, they all have a very similar health plan. Like you said before, they all, not all of them but most of them participate in Merit’s insurance which is a high deductible plan associated with a health savings account. And because most of them have that plan, I’m pretty familiar with how that plans works.

Pat Parkinson: And that plan, high deductible, HSA, great stuff in my eyes. However, not traditional in some ways. This clinic is key to that plan being so popular. Is that correct?

Dr. Matt Eastman: Absolutely.

Pat Parkinson: This clinic is a key component of that.

Dr. Matt Eastman: It’s crucial to that.

Pat Parkinson: Otherwise people would have a different plan.

Dr. Matt Eastman: Maybe. A high deductible HSA plan means that Merit, or the employer, puts a specific amount of money in their health savings account every month or once a year. That’s the patient’s money. They can spend that money, actually on whatever they want. If they spend it on healthcare services that money is tax deductible. But it’s money. It’s real money.

Pat Parkinson: If they spend it on something else they have to pay taxes.

Dr. Matt Eastman: Yeah. Right. But if they don’t spend that money it accrues and accrues and accrues. Because it’s just a debit card. And if you get to age 65, then you can actually use whatever money is leftover in your health savings account for retirement purposes. So it’s real money. Patients view it as real money. So they don’t want to spend it. Just like us. When we have money, we don’t want to spend it. And we want to get good value.

Dan Bischoff: I always want to spend it.

Dr. Matt Eastman: Well you want to get something good for what you spend it on.

Pat Parkinson: I like seeing the HSA add up. Definitely.

Dr. Matt Eastman: Yeah. For sure. So here’s two options. A patient at Merit Medical Systems can use their HSA money to go to an urgent care for their sinus infection. That visit is probably going to ding their HSA by close to $200. Somewhere between $150 and $200 depending on the services that are offered. Or they can come to the clinic at Merit Medical Systems and the visit with me will usually ding their HSA by about $25 or $30. And it’s real money. So the choice to them is, you can spend $200 at the urgent care or you can come to me and spend $25. So that’s a huge incentive.

Pat Parkinson: Merit incentivizes that. The company pays for that incentive to create that incentive. Somebody compensates for that extra $150 right?

Dr. Matt Eastman: Sure. Merit pays for the clinic up front on a monthly rolling invoice, right? So they pay OnSite basically for the service of having a clinic. Merit owns the physical space, but the clinic is managed, run, staffed, all of that business by OnSite Care.

Dan Bischoff: Did I interrupt you?

Dr. Matt Eastman: No, go ahead.

Dan Bischoff: So what can other HR firms do to kind of solve this ambiguity we’re talking about? Is it do something similar that Merit does? What are some, maybe some ideas that HR departments can help the employees with this health consumerism issue that we’re talking about?

Dr. Matt Eastman: Yeah. I think HR departments, what they really can do is they can I guess demand this kind of information. Because in a company that doesn’t have a clinic like Merit does, they don’t really have another onsite advocate for patients other than the HR department, right? So what the HR departments could do is they could gather up as much of this cost information as they possibly can, and they can leverage their business in order to establish these kinds of relationships in exchange for this kind of information. Right?

So if I was a human resources department, I might go to, I don’t know, I might go to a local provider clinic and say I’ve got a lot of patients. I’d like to send them your way. I’d like to have some cost information so that I can tell them. You know, there are those types of relationships that can be established.

Companies that have worked with OnSite in the past have gone to various types of medical providers, laboratories, imaging centers, other types like that and said we want to send you our business, but in exchange for that we need your price list. And they’ve negotiated, not necessarily contracts, but kind of contracts where the prices are transparent and the services are at a reduced rate. There’s things like that that I think HR departments can do.

Pat Parkinson: Awesome. Do you know roughly, even just a guesstimate of how many clinics like yours OnSite Care has?

Dr. Matt Eastman: Yeah. OnSite operates 19 clinics.

Pat Parkinson: And are those in other states?

Dr. Matt Eastman: Most of them are in Utah. There are two clinics currently operating in Arizona and they’ve got feelers out in other parts of the country.

Pat Parkinson: Checking out other opportunities.

Dr. Matt Eastman: But it’s been a situation where OnSite hasn’t really tried, hasn’t really had to try to develop these kinds of business relationships. People see what they’re doing. And oftentimes people come to OnSite and say, we want what you’re providing.

Pat Parkinson: You must be pretty proud of what you do and what Merit does and what OnSite does, as a physician, I mean. Proud might not be the right word, but I think you understand the question.

Dr. Matt Eastman: I think it’s novel. I think that’s what I appreciate most about it. Is that it’s forward thinking. It’s a novel approach. It’s a manner of problem solving that makes things better for everybody involved. It makes things better for patients. We talked about the convenience factor, the cost factor, the ease of access factor. It makes things better for Merit. We talked about how much money they save on a regular basis by people accessing the clinic. And it makes things better for me.

In the job that I worked before this, I was a family physician in a traditional health system in Idaho. And I was a traditional family physician in every way. I saw all ages and all manner of chronic diseases. I did everything you do, but my clinic structured so that I was seeing appointments every 20 minutes. I was constantly running from person to person to person. I was constantly feeling like I didn’t have enough time to get into what I wanted to get into.

I was constantly feeling a little bit of financial pressure from the organization to do more, which meant see more patients. Which meant go faster, do more, spend less time with each individual so that you can pack more into the day. And my incentive was structured, my pay was structured so that the more people I saw, the more I got paid. So it was just a running treadmill of one after another after another after another. And I just had to get really good at keeping the conversation going. I don’t want to sit and listen to you for a half an hour because I’ve got somebody waiting in line right behind you.

Pat Parkinson: That’s tough, man.

Dr. Matt Eastman: Right. But the way it is now at my current job at Merit Medical I have 30 minute appointments. My schedule is routinely got openings in it for same day stuff. I get paid a flat salary so I’m not incented to see more and do more quickly. So it’s made it so that I get upset much less than I did before.

Dan Bischoff: So your patients too, I’m sure right?

Dr. Matt Eastman: It’s made it so that instead of trying to think about how can I do this quickly? I just sit and listen.

Pat Parkinson: You have plenty of time, not plenty of time, but you have much more time.

Dr. Matt Eastman: I have enough time. I have enough time to sit and relax and listen. I have enough time to manage more than one problem at once. So in the old way, if people would come in for one problem and say while I’ve got you can I ask you about this? I would be like no. I don’t have time for that. But now in this situation I’m often bringing up other things that I want to talk with people.

Pat Parkinson: When you say problems, these are problems. We’re talking about health. This is life or death sometimes.

Dr. Matt Eastman: Yeah. That’s right. So it’s been really transformative to me too. I think it’s made me a better doctor. It’s made me a better listener. It’s given me more time to be careful about what I do and to be a little more thorough about what I do. I don’t feel rushed like I always did before. So I think when you have a doctor that’s more comfortable, that’s more relaxed, more at peace about what they’re doing and feels like they’re really contributing to a positive environment like I do, they’re better doctors. So I think it’s made me a better doctor.

Pat Parkinson: That’s very thoughtful man, the way you express it. I was going to ask you what some of the, I mean obviously this is probably a whole other show I’d bet. I was going to ask you some of the most striking differences between then and now and really you’ve spoken to it very well. I don’t know if you have much more to add. You kind of anticipated the question.

Dr. Matt Eastman: I think those are the striking differences. From a perspective of medicine, I’m doing the same stuff I was doing before. I’m managing chronic disease, I’m managing acute illness, I’m doing all the same stuff I did before. I just think I’m doing it better and I’m more relaxed at doing it.

Pat Parkinson: Well I think you’ve given us a lot of time here relative to some of the other recordings we’ve done today. And I think you’ve also given people some really good stuff to listen to. I just want to really close with one more question if it’s ok, it kind of goes back to the conference here. I’m just wondering, you came to this conference again, this is a business conference. What is your message? What did you want to bring today for the audience?

Dr. Matt Eastman: I think the message that I wanted to bring to business is that the more businesses engage with helping their employees navigate a complicated healthcare landscape, the better care their patients will get. A lot of time patients are frustrated, doctors are frustrated and employers are frustrated. But it is possible to approach this problem from a thoughtful and novel perspective.

It is possible to get a little bit outside the box and create relationships like the ones we’ve talked about here that can benefit everybody involved. And that’s only good for business. If you’ve got healthy employees, you’ve got a better business. And I think that’s what we’re seeing at Merit Medical Systems is that employees are happier. They appreciate the benefit that is being offered to them by their employer. And because of that they’ve been more likely to stay employed at Merit Medical Systems.

Pat Parkinson: That’s awesome. You want to spread that word.

Dr. Matt Eastman: Oh for sure. I’ve had multiple people say to me that they had other job opportunities come up but because of the clinic they decided to stay at Merit Medical Systems. It’s huge. So it’s a major advantage for them in recruiting and retaining talent. It’s a major advantage for them in flattening out the cost curve of their healthcare spending. And I really think that’s it the proverbial win, win. That it’s a solution that has solved everyone’s problems and that everyone’s happier because of it.

Pat Parkinson: It’s kind of, not that you were closed minded. Obviously doctors are I’m sure pretty open minded, generally speaking. But it’s kind of like this concept has kind of opened your mind and broadened your horizons as a doctor it sounds like. You’ve been very candid with us today about that.

Dr. Matt Eastman: For many years before, as I said in the beginning, the concept of workplace clinics was kind of a concept of urgent care stuffy nose and that kind of thing.

Pat Parkinson: Donna often referred to it as occupational medicine. Which kind of tells me that it’s a bit more industrial.

Dr. Matt Eastman: Which I didn’t want to do that. I wanted to continue to be a primary care physician. But when I sat down and talked with Donna and really looked at the details of the opportunity I recognized that it’s actual full scope primary care but delivered in a very novel model that solves all kinds of problems.

Pat Parkinson: Seems like you like your job. You like the company you work for.

Dr. Matt Eastman: I do. I do.

Pat Parkinson: That’s cool. Do you have anything else Dan?

Dan Bischoff: No. That’s great.

Pat Parkinson: What a pleasure chatting here with Dr. Matt Eastman. Thank you very much Matt.

Dr. Matt Eastman: Thank you.

Pat Parkinson: Just to let you know one more time, Matt is an MD, a physician who works for a company called OnSite Care. And Matt oversees and manages and heads up a clinic that is on the campus of a very large, very high profile corporation here in the Salt Lake Valley. And Matt, I’ve got to tell you man, I think people are probably just really interested in what they just heard. And it was a great program. And thank you for the time.

Dr. Matt Eastman: Thanks for having me.