In the following excerpts from a VISIONS interview, Wayne Burton, M.D., a nationally recognized expert on health and productivity management, reflects on his career and the status of occupational medicine.
Dr. Burton is retired from JP Morgan Chase (previously Bank One, which was acquired by JP Morgan Chase), where he was responsible for worksite occupational health services at 20 major locations in the United States and Canada and corporate health initiatives and wellness/disease management programs. He recently joined the Center for Health Value Innovation’s Board of Strategic Advisors.
Dr. Burton is the author of numerous articles on links between health risk and medical condition management and improved cost trends at the worksite. He is board-certified in internal medicine, an ACEOM fellow, an associate clinical professor of medicine at the Feinberg School of Medicine at Northwestern University, and an adjunct professor of Environmental and Occupational Health Sciences at the University of Illinois at Chicago.
Q: What specific aspects of your professional experience do you think are most applicable to your new advisory role with the Center for Health Value Innovation, and how do you plan to leverage that experience?
Dr. Burton: (I will) provide expertise on the evaluation of various initiatives in the context of productivity. The center was founded to demonstrate the value of benefit plan designs that encourage compliance with medications to reduce inpatient costs and outpatient and emergency visits. For example, with an evidence-based benefit design, lowering the co-pay for certain medications for conditions such as diabetes, depression or high blood pressure has been shown to increase patient compliance and therefore reduce health care costs linked to treatment and hospitalization.
Until now, research on these designs has focused on these direct costs. We need to further develop the indirect cost side for employers in terms of productivity – short-term disability, absenteeism, and presenteeism. A great deal of my applicable work over the past 30 years has been on the value of mental health benefits, medication adherence, and its association with productivity. (1,2)
Q: What recommendations do you have for provider-based occupational health programs with limited resources to help them develop meaningful ways to demonstrate the value of their interventions, both within their own organizations and externally to client companies?
Dr. Burton: The first metric is the number of injuries/visits per 100 employees. Since they are taking care of more than one company, they can benchmark with other similar companies. I realize some of this is work-related and some non-work-related, and there are differences between reportable and not reported. Some of these physicians may be taking care of non-occupational-related disability, too. If the occupational physician can keep track of the kinds of conditions he or she sees, e.g., musculoskeletal, and non-musculoskeletal, that is a start.
Q: How should occupational medicine practitioners approach the measurement of changes in workforce health status against a baseline?
Dr. Burton: Some occupational health programs are doing biometric screening – blood pressure, blood sugar, cholesterol – for employers. If they are not, they should be. They should be tracking the percentage of “abnormals” and collecting other benchmarking data. Biometric screening is commonly done, but in many cases smaller companies don’t know where to get that kind of screening. The logical place for them to go is the occupational medicine physician. It’s not only valuable information for the employer but for the physician in terms of identifying employees at risk, getting them into treatment, and avoiding injuries and disability.
Q: What should be done to encourage more young men and women to enter the field of occupational and environmental medicine?
Dr. Burton: To get more physicians into occupational medicine, there needs to be more science in the field and training of occupational physicians for the new world. It is the occupational medicine physician who understands medicine, benefits and benefit plan design, wellness, prevention and so forth. A good thing I see in the proposed health care reform legislation – and who knows where that is going – is funding for training in prevention and wellness. Right now there is very little training on that in occupational medicine and internal medicine. There is some, but there needs to be more. And, there needs to be better communication of the research that shows how prevention and wellness affect the bottom line.
Q: Do you believe we are witnessing an opportunity for occupational medicine to reconnect with its public health roots?
Dr. Burton: Absolutely. It’s population health, not just treating injury and illness. When I was with the bank, we brought medical students in to observe our work. A number of them decided to go into occupational medicine because they saw what it is all about.
Q: When you really do retire and look back at your career, what do you think will be your greatest accomplishments?
Dr. Burton: There are three things. First, I am proud we were early adopters of integrated databases (in 1987). Second, I am proud of our focus on mental health. We came out and said what an important cost it is for an employer. It ended up on the front page of the Wall Street Journal. The headline referred to “Banker Blues.” This could have been negatively perceived, but our management said it was great recognition for our company. It led us to do a number of important things at the bank with mental health interventions and research. Third, I am very proud of the support we have had from Dr. Dee Edington (director of the University of Michigan’s Health Management Research Center) and others on the links between workforce health and productivity.
