By Liora Engel-Smith

The semi-trailer that’s become a staple in the McRae Industries parking lot has nothing and everything to do with making shoes. The white and green truck doesn’t deliver leather for boots, nor does it shuttle uppers to a nearby sewing factory.

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But people here say the two-axle vehicle is every bit as essential to the smooth operation of the factory at Mount Gilead, a Piedmont-region rural town of just under 2,000. The 300 employees here cut and sew leather for what will become boots for the U.S. and Israeli militaries. Workers in another McRae facility four miles north of Mount Gilead finish the boots and add soles.

The semi that visits the factory in Mount Gilead once a week is a mobile clinic. It comes fully equipped with a waiting and triage area, a sink and bathroom and an exam room. It’s also staffed with a physician assistant and a licensed practical nurse who provide basic primary care, from tests to blood pressure and diabetes screenings to medication refills and treatment of minor infections.

A mobile clinic van is parked in front of a red brick building
FirstHealth’s mobile clinic serves several local businesses. The service, which employers purchase, providing primary care services to employees for free. Photo credit: Liora Engel-Smith

The service is free for employees. There are no copays or health insurance requirements in order to be seen. Hourly employees don’t even have to clock out before they come to the trailer at the edge of the parking lot. McRae pays a flat daily fee for the clinic, which belongs to Pinehurst-based health care network FirstHealth of the Carolinas.

As health care costs soar for both employers and employees, keeping the bottom line in check while helping employees stay healthy has become a significant challenge. The mobile clinic has helped McRae with both goals, said Kay Martin, consultant and former vice president of human resources at the Montgomery County-based company.

“If we can prevent one heart attack by the care that this person continues to receive for their blood pressure, if we can promote wellness and identify the primary cause that might develop into a high dollar claim, then we have been successful,” she said.

A health and cost challenge

McRae’s challenge is more acute than most. Similar to other rural populations, many workers there have diabetes, high blood pressure and other chronic diseases. If left unchecked, these conditions can be costly to treat.

The average cost of diabetes care per person, including emergency department visits and medications, is just under $10,000 a year. The average cost of care for heart failure is more than double that.

A closeup of a hand getting blood sugar checked.
Berry Harris, a maintenance employee at McRae Industries gets his blood sugar checked at the FirstHealth mobile van. Also in the photo is Vicky Doby, a licensed practical nurse at FirstHealth. Photo credit: Liora Engel-Smith

McRae is self-insured, which means that the company is the financial backer of any health insurance they offer and needs to retain enough reserve to cover expensive diagnoses. The bootmaker must also pay a portion of every doctor’s visit, every medication and every emergency department visit employees incur, after copay and deductibles, Martin said.

Those costs can add up fast.

At the same time, the company found, employees were reluctant to go for basic medical care for any ailments because it meant taking off a few hours or even a half a day from work to keep doctors’ appointments.

Instead, maintenance worker Berry Harris visits the mobile clinic every few weeks to monitor his Type 2 diabetes. The 61-year-old gets his blood sugar checked and his prescriptions at the clinic. Since the clinic is free, Harris saves roughly $20 a visit by seeking his care here. He estimates that alone amounts to several hundred dollars a year.

“It’s free and they give you the same thing, so why not?” he said.

His health has improved, too. He’s lost three pounds since his last visit and he’s watching his carbohydrate intake, though he still eats sweet potato fries every once in a while, he said.

A supplement, not substitute

On an average day, physician assistant Darrin Cutrell sees several patients like Harris, either at McRae or other Montgomery County companies he works with.

Every so often, he encounters a real emergency that he alone can’t treat. In his three years of working with McRae, he’s diagnosed his share of prostate and breast cancers, but one day, a patient walked into the clinic with complaints of indigestion. That worker turned out to be in the middle of a heart attack that required emergency bypass surgery, Cutrell said.

And though Cutrell can draw blood and write prescriptions, employees still need their health insurance to pay for medications, specialist appointments and screenings such as mammograms.

While most employees at McRae are insured, Cutrell has worked with a few patients who aren’t. Even with cheap prescription drugs and the range of tests he can do in the mobile clinic, Cutrell’s services can’t totally address the health needs of workers. That’s not uncommon for workplace wellness clinics, said Larry Boress, executive director of the National Association of Worksite Health Centers, a membership organization based in Dallas, Texas.

A man in a hat is getting his blood pressure checked
Berry Harris, a maintenance employee at McRae Industries gets his blood pressure checked at the FirstHealth mobile van. Also in the photo is Vicky Doby, a licensed practical nurse at FirstHealth. Photo credit: Liora Engel-Smith

“People still have to get therapy, hospital care and specialty care and centers can’t offer these services,” he said. “ … the [workplace health] center can’t be another fragmentation of the health care system. It has to be incorporated into the system. That’s the only way you’re going to get quality care.”

Cutrell can, however, help workers manage chronic conditions such as diabetes and blood pressure at no additional cost to them. He can also see patients who suspect they have coronavirus via telehealth. Because McRae pays a flat fee for the service, Cutrell can check in with workers as often they need it.

And because people are at work, it’s easier to find and follow up with those workers.

“I can see them as many times as I need to to drive home the message, or make sure their medication is working and that they’re doing well.”

Barbara Pemberton, who works at McRae’s human resources department, has used the service many times over the last three years. The 57-year-old said the option is so convenient that she sees Cutrell for all of her primary care needs. Lately, she said, she’s needed help managing her blood pressure.

“It’s right here, and if I have a problem, it’s easy to come in,” she said.

A growing service

Workplace wellness services aren’t new, but their popularity is growing among larger employers, Boress, from the worksite health center association, said. The association estimates that roughly half of workplaces with more than 5,000 employees have some form of wellness services at the workplace, though the exact number is unknown because these centers do not need a license to operate.

A nurse in blue and black scrubs uses an ear thermometer on a blonde woman.
Debbie Saunders, an employee at McRae Industries in Montgomery County, visits the FirstHealth mobile clinic. Also in the photo is Vicky Doby, a licensed practical nurse at FirstHealth. Photo credit: Liora Engel-Smith

Companies also vary in the array of services they offer at their centers. Some employers offer free or reduced-price dental care, for example, while others focus on primary care or health screenings. Some bill insurance companies for services, while others do not.

Soaring health care costs and the desire to keep employees healthy and productive are driving the trend, Boress said. The wide variation in these clinics makes it difficult to evaluate the potential for cost saving on a larger scale.

FirstHealth’s model, however, is working, Cutrell said. The company serves five employers across Montgomery County and the health network is looking to expand its workplace services to neighboring counties, including Randolph and Lee, although the pandemic has slowed that process down.

Martin, of McRae, said the company plans to continue with FirstHealth, though the service has not entirely addressed every employee’s health needs.

“It’s a problem that continues to evolve with our people’s health,” she said. “But so far, I definitely think [the mobile clinic] impacted so many people’s lives in a positive way.”

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Liora Engel-Smith joined NC Health News in July 2019 and covers policies, programs and issues that affect rural areas. She has previously worked for the The Keene Sentinel in New Hampshire and the Muscatine...