For most of the last twenty years, onsite health clinics were a benefit reserved for very large employers. If you had ten thousand employees on a single campus, an onsite clinic made obvious sense — the math worked, the vendor list was short, and the implementation was straightforward.
For everyone else — the mid-market employer with 100 to 1,500 employees, often spread across multiple sites — the answer was always more complicated. This piece is a plain-language primer on what onsite clinics actually are, what they cost, and which version makes sense for which employer.
The four flavors
The category called “onsite” actually breaks into four distinct models:
1. Full onsite. A clinic physically located on the employer’s campus. Full-time staff. Built-out clinical space. Best fit for single-campus employers with 1,000+ employees.
2. Hybrid onsite. A clinician is physically present 1-3 days/week and provides virtual care the remaining days. Same NP, same EHR, same continuity. Best fit for employers between 100 and 800 employees, especially those with a smaller dedicated space.
3. Near-site. A shared clinic located near (but not on) employer campuses, serving multiple employers. Trades the convenience of true onsite for shared cost. Best fit for groups of small employers in the same geography.
4. Virtual-first with onsite touchpoints. Primary care delivered virtually with occasional in-person events (annual physicals, biometric screenings, vaccine clinics). Lowest setup cost. Best fit for employers under 150 employees or with highly distributed workforces.
What each costs
Costs are typically expressed as PMPM (per-member-per-month) — the monthly fee per covered employee, all-in.
- Full onsite, legacy vendor (Fortune 500 model): $80-$140 PMPM, plus six- or seven-figure setup fees. Member utilization in the 60-80% range.
- Full onsite, mid-market vendor (NP-led): $35-$65 PMPM, with five-figure setup. Member utilization in the 150-250% range.
- Hybrid: $25-$45 PMPM. Setup is modest — the clinic space is smaller and shared infrastructure does more work. Utilization tracks full onsite.
- Near-site: $20-$40 PMPM, often lower setup. Utilization runs lower than onsite (40-90%) because the convenience friction is real.
- Virtual-first: $10-$25 PMPM. Setup is mostly software. Utilization depends heavily on member onboarding.
These ranges assume the clinic is bundled with onsite or direct pharmacy. Pharmacy alone often saves more than the clinic fee.
When does it pencil?
The headline question every benefits leader asks is some version of “what size do we need to be for this to work?” The honest answer depends on which model:
- Full onsite (legacy): 1,500+ employees on a single campus.
- Hybrid (NP-led): 100-1,500 employees, single or multi-site.
- Near-site (shared): Any size, if a near-site clinic already exists in your geography or you can pool with other employers.
- Virtual-first: Any size.
For most mid-market self-funded employers, the question isn’t whether onsite primary care makes sense — it’s which version. The model that fit a 250-employee logistics company is not the model that fit a 5,000-employee enterprise client a decade ago. The category has split.
What to ask
When evaluating vendors:
- What’s your average member utilization? Anything below 100% is a yellow flag. Real onsite clinics see members more than once a year.
- What’s the ratio of MD to NP hours? NP-led models are not “less than” — they’re a different staffing structure that often delivers higher continuity and equivalent outcomes at a lower cost.
- How does pharmacy work? PBM-routed onsite pharmacy and direct-purchase onsite pharmacy are different products with very different economics.
- What’s the implementation timeline? Six to twelve months is legacy. Four to eight weeks is current.
- Where do savings come from? A vendor who can’t articulate the source of the savings — fewer ER visits, lower urgent care utilization, direct pharmacy margin, reduced specialty referrals — is selling something else.
Onsite primary care is one of the highest-leverage tools in employer healthcare. The question is which version, sized for which employer, with which set of structural assumptions. The answer is rarely the off-the-shelf legacy product.