If you run benefits at a company with 100 to 1,500 employees and you’re researching onsite primary care, you’re about to discover something the vendor brochures won’t tell you: most of the biggest names in the onsite clinic industry weren’t built for you.
They were built for the Fortune 500. The economics, the staffing model, the technology stack, the renewal cycle — all of it was designed for a 5,000-employee single-campus enterprise client. When the legacy vendors quote a smaller employer, they’re retrofitting a model that was never meant to fit.
What the legacy model assumes
The legacy onsite clinic industry — Premise, Marathon, Crossover, Everside, the rest — was built around a few load-bearing assumptions:
- The employer is large enough to dedicate a full-time MD and a multi-person staff. That’s the unit economics floor. Below it, the per-visit cost goes the wrong direction.
- The employer has the bandwidth to manage a complex vendor. Legacy contracts run 60+ pages. The implementation timeline is six to twelve months. The renewal cycle assumes a benefits team with a vendor manager and a procurement function.
- The employer can absorb a six- or seven-figure setup fee. Build-out costs alone often exceed $250K before the first patient is seen.
For a 280-employee logistics company with one HR person and a broker, none of those assumptions hold.
What we built instead
Archer was built specifically for the segment that legacy vendors disqualify: 100–1,500 employees, self-funded or level-funded, often with hybrid coverage needs and a workforce that doesn’t sit on a single campus.
That meant rebuilding the model from the ground up:
- NP-led care, MD oversight. A nurse practitioner with primary care experience runs the day-to-day clinic, supported by an MD medical director. Continuity is the point — the same NP, every visit.
- Hybrid by default. A clinician who is physically onsite two or three days a week can serve a workforce five days a week through virtual visits. The economics work at lower headcount because the staff isn’t underutilized.
- Onsite pharmacy that bypasses PBM markup. Direct purchasing, formulary tuned to the population, walk-out fills. No rebate games.
- 4-6 week implementation, not 9-12 months. We’ve done this enough times to know what’s load-bearing and what’s overhead.
What this means for your renewal
If you’re a self-funded employer in this size range and a legacy vendor has told you onsite isn’t for you, that’s not a fact of nature — it’s a function of who the legacy vendors are built to serve. Run the math on a model designed for your segment instead. The number changes.