THEWALL STREET JOURNAL. Tuesday, January 9, 2018 | A9

LIFE&ARTS

JASON DRAGOO’S Stanford Uni-versity research team gets 100 to200 inquiries every day from peo-ple interested in joining its clinicaltrial studying the use of stem cellsto treat knee injuries.

The interest highlights a grow-ing demand for the use of stemcells derived from a person’s ownbone marrow or fat to treat ortho-pedic injuries. Osteoarthritis, a de-generative joint disease where theprotective tissue or cartilagearound a joint wears down, is aparticular focus of inquiry.

Stem cells have the potential todevelop into different kinds of cells,making them a potentially valuabletool in treating orthopedic injuries.

The U.S. Food and Drug Adminis-tration has cracked down on theexplosion of private stem-cell clin-ics that offer treatments for every-thing from muscular dystrophy toosteoarthritis. It has accused clinicsof making false claims and illegallygrowing human stem cells ex-tracted from patients, which is al-lowed in many other countries butnot the U.S.

But a growing number of aca-demic research centers and hospi-

tals are offering stem-cell injectionsto treat orthopedic injuries in away the FDA condones, by extract-ing bone marrow or fat, which isspun in a centrifuge before beinginserted into the patient’s joint inthe same day.

Due to a lack of research, thetreatments generally aren’t coveredby insurance companies and cancost thousands of dollars. Still, de-mand is high.

“There are just so many agingbaby boomers who want to be ac-tive,” says Joanne Borg-Stein, anassociate professor of physicalmedicine and rehabilitation at Har-vard Medical School. “They are ei-ther too young for a joint replace-ment or their arthritis isn’t badenough, and they’ve done othertreatments and they’re not able tostay active.”

She says requests for stem-cellinjections are outpacing the re-search on it, which is scant. Ex-perts say such injections can re-duce inflammation and pain but it’sunclear how long their effects lastor if they help regenerate cartilage.

At Harvard, doctors have beenPlease see STEM page A10

years, according to ChiefExecutive Stuart Clark. “Anon-site health center usedto be a nice-to-have nov-elty,” he says, “but it isnow considered a main-stream benefit for a largeemployer.”

In competitive labormarkets, an on-site cliniccan mean an edge in re-cruiting says Larry Boress,who heads the National As-sociation of WorksiteHealth Centers, a trade associationfounded in 2012. “If you go to Sili-con Valley, [companies] are tre-mendously competitive with theiron-site centers because people cango anywhere, and they will ask,‘Do you have an acupuncturist?[Do you have] a chiropractor?’ ”Mr. Boress says.

A 2014 study by his organiza-tion estimated that 30% of Ameri-can businesses of all sizes had on-site medical care for employees.By 2018, around 50% will offer theservice, Mr. Boress says, citing amore recent industry study whichfound that an additional 11% offirms were considering establish-

ing clinics by 2020. Thelevel of care varies, hesays, from a single nurseto a team of primary-carephysicians and specialists.

Premise is one of thenation’s largest managersof on-site health clinics, ac-cording to the firm’s CEO,Mr. Clark. The companywas founded in 2014, withthe merger of two compa-nies, one dating back tothe 1970s. The industry has

evolved from decades ago, he says,when health care at work oftenconsisted of a company nurse whodispensed aspirin.

Many clinics are located withina company’s premises or campus.Others are nearby and serve em-ployees as well as their families. Inthis month alone, Premise will

HEALTH & WELLNESS

The Doctor Is In—atWorkAs on-site health centers take hold, employers add features such as specialists, acupuncturists and vegan cooking lessons

ON WEDNESDAY mornings, Ste-phen Fealy, an orthopedic surgeonin New York, heads downtown tosee his patients. But instead of go-ing to his office, Dr. Fealy sees pa-tients in theirs—at Goldman SachsGroup Inc.

He examines a couple of dozenGoldman employees, from manag-ing directors to junior analysts andadministrative assistants.

Dr. Fealy, a sports-medicine spe-cialist with the Hospital for Spe-cial Surgery in New York, worksalongside several other physiciansat the Goldman Sachs clinic on the10th floor of the firm’s headquar-ters, near Wall Street.

Getting out of his hospital digsmakes Dr. Fealy feel a bit like doc-tors of old who made house calls.Now, when employees all but liveat the office, it makes sense to seethem there.

“These people work incrediblyhard, they come in with back pain,hip pain,” he says of his Goldmanpatients. Dr. Fealy treats cases ofwhat he calls “investment-bankerneck,” an arthritis that can afflictpeople in their late 40s, particularlyones peering at lots of monitors.

Employers hoping to keep work-ers healthy and productive aremoving beyond yoga workshopsand webinars on work-life balance.More and more businesses are es-tablishing on-sitemedical clinics,where employeescan receive primarycare and in somecases consult withspecialists—allwithout venturingfar from work.

Many companiesview the clinics asa means to dealwith crushinghealth-care costswhile making sureemployees get ade-quate care and at-tention. Others, inSilicon Valley andelsewhere, considerthem an essential hiring and re-tention tool. Some clinics boastthat they offer a better experiencethan traditional doctor visits, be-cause they don’t make patientswait or rush physicians throughconsultations.

At Goldman Sachs in New York,staff can access an emergency phy-sician any weekday and see rotat-ing primary-care physicians andspecialists including a dermatolo-gist and a gynecologist, as well asDr. Fealy, the orthopedic surgeon.There are physical therapists onhand as well as a visiting physiat-rist, a specialist in rehabilitationmedicine.

Premise Health, located in theNashville, Tenn., suburb of Brent-wood, oversees Goldman’s center.The firm, like the rest of the in-dustry, has grown swiftly in recent

BY LUCETTE LAGNADO

oversee the opening of 33 healthcenters offering various levels ofservice, most centered around pri-mary care. Five years ago, thecompanies that went on to makeup Premise presided over a similarnumber of openings during an en-tire year, Mr. Clark says.

On-site clinics have becomemore elaborate. In 2016, CumminsInc., a maker of engines, genera-tors and related products, openedthe Cummins LiveWell Center, a28,000-square-foot health centeron its main campus in Columbus,Ind. At LiveWell, employees canmeet with primary-care physi-cians, an optometrist, a gynecolo-gist, and a physician assistant whospecializes in dermatology. Thecenter, which is decorated withpaintings and other art, has lifecoaches and a room for massagetherapy. A chef comes in to dem-onstrate how to cook “plant-based” vegan meals.

LiveWell tries “to go a little be-yond traditional American [health]care,” says Jon Mills, a seniorspokesman.

On-site clinics are flourishingbecause employers are increas-ingly desperate, says Mr. Clark ofPremise Health. “Health-care costsare totally out of control in thiscountry at the same time the pop-ulation is getting sicker.”

When employees see a primary-care doctor at one of Premise’s on-site health centers, they typicallydon’t pay more than a nominal fee,

Please see CLINIC page A11

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YOUR HEALTH | By Sumathi Reddy

THEMYSTERY OF STEM CELLS FOR KNEE PROBLEMS

Premise Health CEO Stuart Clark, above, says business isbooming. Left and below, the Cummins LiveWell Center.

SCIENCE

SOURC

E

Knee osteoarthritis is a difficult-to-treat and painful condition affecting millions of people. Experts are researchingstem-cell injections from a patient’s own bone marrow or fat as a treatment to avoid more invasive surgeries.

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THEWALL STREET JOURNAL. Tuesday, January 9, 2018 | A11

LIFE & ARTS

A BRIGHT LIGHT in the darknessthat follows the end of the holi-day season, the 14th WinterJazzFest begins in New York onWednesday and ends a week later.As in years past, it features animpressive cavalcade of artists,both domestic and international,many of whom don’t necessarilyadhere to a traditionalist’s defini-tion of jazz. Rather, WinterJazzFest is a wide-ranging cele-bration of black music rooted injazz and the blues, played by free-thinking musicians who pursueadventures in creativity.

Like major rock festivals, Win-ter JazzFest is all too much andyet somehow just right for today:It speaks to the modern musicscene’s rich diversity, a trait thatwill send attendees careeningamong 12 venues to try to hear asmany high-spirited and technicallyaccomplished players and vocalistsas possible, well aware that thereare likely to be moments of impro-visational magic that may never bereplicated. Scheduling conflictsabound: The marathons on Fridayand Saturday that run from eve-ning until way past midnight makeup the spine of the festival.

Well-established musicians DonByron, James Carter, Stefon Har-ris, Fred Hersch, Nicholas Paytonand Marc Ribot are slated to ap-pear. Pianist Vijay Iyer will playwith saxophonist Ernest Dawkins,while Jason Moran sits in with oneof the groups led by flutist NicoleMitchell. The festival’s artist-in-residence, Ms. Mitchell will leadfour different units in concert, in-cluding one that’s on a bill withTyshawn Sorey, the 2017 Mac-Arthur Fellow, who will perform asolo percussion set.

In addition to the headliners,sneaking in seemingly undercoverare the prized vocalists ClaudiaAcuña, Becca Stevens and SheilaJordan. Ms. Acuña will sing withpercussionist Susie Ibarra’sDreamTime Ensemble; Ms. Stevensin a duet format with experimentalharpist Laura Perrudin; and 89-year-old Ms. Jordan, former asso-ciate of Charlie Parker, with bass-

is in her voice,” she said.Among the featured programs is

a Monday tribute to pianist, com-poser and educator Geri Allen,who died last year, organized byher longtime friend and collabora-tor, drummer Terri Lyne Car-rington. Among the musicians whowill perform at the Martin LutherKing Jr. Day show: Dee Dee Bridge-water, Ravi Coltrane, Jack DeJoh-nette, Linda May Han Oh, Esper-anza Spalding and Mr. Iyer. Mr.Coltrane will present a Sundayconcert in honor of his mother, Al-ice Coltrane, who died a decadeago. Other special events includetrumpeter Wadada Leo Smith per-forming with the improvisationalart rockers Deerhoof and vocalistJosé James revisiting the music ofsinger-songwriter Bill Withers.

When discussing WinterJazzFest, it’s tempting to fall downthe “what is jazz?” rabbit hole. Butthat’s a fruitless debate for musi-cians as well as fans. On his latest,wide-ranging album, “Afro-Carib-bean Mixtape,” Mr. Payton, a NewOrleans native, makes clear theword “jazz” has no meaning forhim. When we spoke by phone lastweek, he reiterated the point. “Theterm ‘jazz’ is problematic,” hesaid. “‘Black music’ is better suitedto what I do. I draw from the Afri-can diaspora.”

Said Ms. Mitchell, “Black musicis inclusive. It doesn’t exclude any-one from contributing to it.” Onher 2017 album “Mandorla Awak-ening II: Emerging Worlds,” sheperforms with musicians who playtraditional Japanese percussion,stringed and wind instruments aswell as electric guitar and cello.She will appear with that aggrega-tion at the festival.

Thus, what the festival offers ismusic that’s exceptional, variedand welcoming; taken together, itcan inspire. For listeners with anappetite for the unexpected, Win-ter JazzFest is the place to be.

Mr. Fusilli is the Journal’s rockand pop music critic. Email him atjfusilli@wsj.com and follow him onTwitter @wsjrock.

MUSIC REVIEW | By Jim Fusilli

An All-InclusiveWinter JazzFest

if that. An on-site health center “is in addi-tion to, not instead of” a traditional healthinsurance plan, Mr. Clark emphasizes. Em-ployees invariably are covered by health in-surance and can go to outside physiciansanytime they wish. In cases where peoplehave high-deductible plans, they pay moreto go to the on-site center.

The centers that Premise operates cancost anywhere from $250,000 to $20 mil-lion or more annually, Mr. Clark said,citing one client company with40,000 employees.

Premise hires the physi-cians and pays them a sal-ary. These clinics “have tosave more money thanthey cost,” he says, withthe host company seeinglower insurance costsand better health out-comes.

At Goldman Sachs, pa-tients pay doctors andspecialists at the on-siteclinics through their in-surance plan, just as ifconsulting with them pri-vately; typically, thatmeans a copayment.

That tends to be thecase in the New Yorkmarket, Mr. Clark says. Inother health centersaround the country thatPremise runs, he hiresspecialists to come incertain days a week, soemployees don’t paymuch or use their insur-ance even to consult witha cardiologist or derma-tologist.

Cisco Systems Inc., ofSan Jose, Calif., offers bothan acupuncturist and a chiro-practor, along with primary-care physicians and pediatricians,says Katelyn Johnson, a senior integratedhealth manager at the technology company.

Ms. Johnson oversees the on-site clinicsknown as LifeConnections at Cisco’s SiliconValley headquarters along with ones atCisco facilities in North Carolina’s ResearchTriangle Park and India.

“We are combining Western with Eastern[medicine],” Ms. Johnson says. That meansaccess to doctors connected with StanfordHealth Care as well as alternative-medicinespecialists.

Cisco has been working directly with theStanford health system to operate the on-site clinic. Ms. Johnson says LifeConnectionspledges no waiting time for employees orfor their children consulting a pediatrician.“Physicians have slots for same-day service,”she says. “We make sure you get in.”

ContinuedfrompageA9

John Jackson, who oversees Stanford’sCorporate Health Programs, says his divi-sion has been expanding as the health sys-tem forms more relationships directly withemployers. Stanford can compete withfirms operating on-site clinics, he says, bycoordinating between primary-care doctorsand its own specialists on complex cases.

Mr. Clark of Premise Health says someon-site health centers, such as the one atCummins, don’t even have waiting rooms.He believes the clinics save time by elimi-nating paperwork and administrative tasksthat burden most doctors’ offices. In hiscontracts with various companies, Mr.

Clark says, performance guaranteessometimes stipulate waits of less

than five minutes. Employeeswalk in or make appoint-ments with an app or aphone call. Doctors usu-ally allot a generous 30minutes per patient.

Mr. Clark also saidany privacy concernsthat some might haveabout on-site clinicswere unfounded. Hecited the tough HealthInsurance Portability andAccountability law thatregulates sharing healthinformation. “It is thelaw of the land, and weare not going to breakit,” Mr. Clark says.

Arthur Caplan, a bio-ethicist who overseesthe division of medicalethics at the NYU Schoolof Medicine, agrees thathealth information isprotected: “When youremployer pays for a bou-tique health center, theycannot see your personalhealth information.”Still, he adds, there are

risks. “But they do knowgeneral information which

may hurt you, if the numberof employees is small. The em-

ployer will know if there is asurge, say, in the percentage of workers

who are seeking help with anxiety or drugaddiction.”

Over the years, Kane Brenan, a managingdirector at Goldman Sachs, has dealt with anumber of ailments.

“I have had knee surgery, a sprained an-kle, I have had a bad back [and] hip,” hesays and being able to see Dr. Fealy, his or-thopedic surgeon, and other doctors at theoffice is a big plus.

Having physical therapists close by alsomakes it easier to stick to his twice-a-weektreatment regimen.

“It is remarkably convenient,” Mr. Bre-nan says, “rather than a four-hour roundtrip to get somewhere, you take the eleva-tor down, you have a 45-minute session,and you are back at your desk.”

CLINIC

At some on-sitecenters, employees cansee an acupuncturist or

a chiropractor.

ist François Moutin and vocalistKavita Shah. The exquisite guitar-ist Brandon Ross performs withhis acoustic quartet and then withthe eight-piece electric ensembleHarriet Tubman Plays Free Jazz.Trumpeter Marquis Hill plays withhis quintet Blacktet and also joinstrombonist Theo Croker in his 14-piece Big Brother.

But Winter JazzFest is hardlyabout what’s familiar. As befits im-

provisational music, it’s about dis-covery. With his band the MerryPranksters, Dave Harrington willplay what he called “free jazz witha back beat” influenced by MilesDavis’s “Bitches Brew” electricfunk period. Trumpeter Yazz Ah-med will feature the jazz-electron-ica blend of her 2017 album “LaSaboteuse,” while fellow trumpetplayer Jaimie Branch will explorethe music of her “Fly or Die,” re-

leased last year. (Ms. Branch isalso a member of Harriet TubmanPlays Free Jazz.) The trio theComet Is Coming will bring itshard-hitting mix of funk, jazz androck as evidenced on its 2017 EP“Death to the Planet.” The vocalistFay Victor will front a trio, Sound-NoiseFUNK; when we spoke byphone last week, Ms. Mitchell wasunreserved in her praise for Ms.Victor: “The whole legacy of jazz

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Clockwise from above: NicholasPayton, Fay Victor and Nicole Mitchellwill all perform at the festival.

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