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Integrated Physical Medicine at Employer-Sponsored Health Clinics Improves Quality of Care at Reduced Cost

Lord, Daniel J., DC, CCSP; Wright, John R., MSc; Fung, Rebecca, DPT; Lederhaus, Eric S., DPT; Taylor, Katie, PhD; Watts, Sharon A., MA; Hagg, Heather K., PhD; Bravata, Dena, MD, MS

Journal of Occupational and Environmental Medicine: January 10, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/JOM.0000000000001536
Original Article: PDF Only

Objective: To evaluate clinical and economic outcomes associated with integrating physical medicine in employer-sponsored clinics.

Methods: Retrospective cohort analysis comparing clinical and economic outcomes of physical medicine services delivered in employer-sponsored clinics with the community.

Results: Integrating physical medicine in employer-sponsored clinics decreased wait times to access these services to 7 days (2–4x faster than in the community). Patients receiving care in employer-sponsored clinics experienced marked improvements in fear of pain avoidance behaviors (p < 0.00001) and functional status (p < 0.01) in 8 fewer visits than in the community (p < 0.0001), resulting in $472-$630 savings/patient episode. Non-cancer patients received 1/10th the opioid prescriptions in employer-sponsored clinics compared to the community (2.8% vs. 20%). Patients were highly likely to recommend integrated employer-sponsored care (NPS = 84.7).

Conclusions: Findings suggest robust clinical and economic benefits of integrating physical medicine services into employer-sponsored clinics.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Crossover Health, San Clemente, CA (Daniel J. Lord, John R. Wright, Rebecca Fung, Eric S. Lederhaus, Katie Taylor, Sharon A. Watts, Heather K. Hagg, Dena Bravata); Stanford University, Center for Primary Care and Outcomes Research, Stanford, CA (Dena Bravata); Untold Content, Cincinnati, OH (Katie Taylor, Sharon A. Watts).

Address correspondence to: Dena Bravata, MD, MS, 1840 Lexington Av; San Mateo, CA 94402 (

External support: There was no external support for this work, it was fully supported by Crossover Health.

COI: All authors were either employees of or consultants to Crossover Health at the time of analysis. None other declared.

The authors report no conflicts of interest.

Copyright © 2019 by the American College of Occupational and Environmental Medicine