By Karen O’Hara
The value proposition in occupational health is getting a lot of attention these days as programs are being called on to demonstrate their worth to clients, prospective customers and their own organizations.
This is particularly true for hospital based programs as health system executives look for ways to eliminate or reduce what they consider to be “non-core” services in an effort to streamline operations and cut costs. Even in small and rural markets where there is minimal competition, it is essential to be able to validate a program’s core contributions to its parent organization and the community at large in order to sustain management commitment to an occupational health initiative.
Linda Ramey, vice president of occupational health at Habersham Medical Center, located in the little town of Demorest, Ga., is among members of the National Association of Occupational Health Professionals (NAOHP) who have given a great deal of thought to the question: “How important is occupational health to your organization?”
Ms. Ramey’s short answer is: “If you have employers in your service area, it’s very important!” But if the short answer isn’t sufficient, she has a PowerPoint presentation, client testimonials and hospital management to back it up.
Wiser Approach
To date, the medical center’s program, WorkWise (“A wiser approach to occupational health services”), has remained somewhat insulated from the recession. However, that doesn’t mean the program intends to rest on its laurels.
“Luckily, we haven’t seen much of a decline in business,” Ms. Ramey said. “One thing we have learned about occupational health and steerage into the hospital is that employers really need the services. That’s why it’s so important to get it right the first time. Word of mouth is how you get your business.”
The WorkWise delivery model is well-suited for a rural area. Rather than operate its own clinic, WorkWise employs three full-time staff members who focus on helping employers, patients, providers and payers navigate the local health care delivery system. WorkWise services are delivered at the worksite and via the hospital emergency department, lab, radiology, outpatient rehabilitation and other relevant departments, two primary care physicians and a physician assistant in the community.
WorkWise staff function as “trouble shooters” by taking definitive steps to ensure timely treatment and follow-up, effective communication among all parties, prompt patient scheduling and accurate billing. Hospital staff and designated physicians are trained on protocols established and reinforced by WorkWise.
By listening to their needs and meeting their expectations, Ms. Ramey said the program has been able to build a strong level of trust with employers in the region. Confidence in a provider’s ability to produce positive outcomes is particularly critical in Georgia, where employers are required to designate a panel of at least six physicians from which an injured employee may choose. WorkWise has been able to leverage its relationships with employers and patients by becoming a preferred panel provider with access to specialists who are also qualified panel providers.
To solidify the provider-employer relationship, company representatives are asked to sign off on their company’s protocols (contact names, insurance information, drug screening policies, surveillance requirements, etc.) and invited to review and update them every six months. In 2000, the program had approximately 12 local companies who used them sporadically; today it has more than 300 protocols on file representing clients in northern Georgia and some whose corporate offices are located in other states.
Productivity Model
The WorkWise team functions under a productivity system based on predetermined goals. For example, during the budget process, the hospital’s chief financial officer sets standards for the number of anticipated patient encounters per month in certain service categories such as drug screens, injury care and physical exams. The occupational health program monitors activity and constantly looks for ways to raise that bar.
“If you hire the right type of people and show them you are willing to roll your sleeves up and work alongside them, they will give you their very best. I am fortunate to have that kind of team. We are always within or above our target in visits,” Ms. Ramey said. “I tell those hospital departments that provide occupational health services to remember that every person who walks through the door gives us the opportunity to meet an expectation. If we provide quality occupational health, the patient assumes all hospital and physician services are the same.
“Everyone must work together to create success. We meet regularly with every occupational health provider to review services and address any issues that need improvement. Our president, chief financial officer, and clinical and non-clinical leaders support, and sometimes attend, these sessions, which reiterates to employees that they support the program.”
Meanwhile, the program tracks the business it generates for various hospital departments. The findings are shared with Quorum Health Resources (QHR), a hospital management firm under contract to the hospital. It is QHR’s stance to embrace the contribution of occupational health and the steerage it brings into the hospital and supporting physician practices. Tracking mechanisms show that occupational health generates more than $1 million in net revenue annually through the hospitals and clinics, not including revenue generated for physician practices and ancillary departments.
Employee Health
In addition to providing services to employers in a five-county region, WorkWise assumed responsibility for the hospital’s worker’s compensation program in January 2007. Since then, it has been working closely with the hospital human resources and employee health departments on workplace health, workers’ compensation, and risk management interventions.
By enforcing certain policies such as mandatory post-accident drug and alcohol screening, accident investigations and an aggressive return-to-work program, the self-insured hospital has reduced its workers’ compensation claims rates and associated costs. The hospital recently received an award from the Georgia Hospital Association’s (GHA) Self-insurance Workers’ Compensation Fund in acknowledgment of its success in reducing claims and related costs. It was also recognized by the GHA Partnership for Health and Accountability (PHA) last year for efforts aimed at reducing the risk of medical errors and improving patient safety and medical outcomes. It reported a 5 percent reduction in premiums for 2009.
“Managing costs is not fun, but in today’s healthcare environment it is a necessity to make ends meet,” said hospital CEO Richard Dwozan. “As a member of the Board of Directors for the GHA’s self-funded plan, I know the effort that goes into keeping premiums down. I encourage all of my health care colleagues to embrace programs that are effective in managing claims experience.”
Onsite Services
Among WorkWise’s comprehensive slate of product offerings, Ms. Ramey said onsite health/wellness screenings utilizing PRN nurses has been particularly well received in the market. “A lot of hospitals struggle with this,” she noted, “but if you tailor the program for individual companies in response to their experience and insurance and claims costs, it’s not a difficult sell.”
When employers request health screening activities without a follow-up plan, WorkWise strongly encourages them, at a minimum, to offer interventions to employees with identified health risks. In addition to coronary risk profiles, and glucose and cholesterol checks, WorkWise can also arrange for workforce prostate-specific antigen (PSA) screening, mammograms and colonoscopies – all of which can generate downstream revenue for the hospital.
“We send one of our physicians onsite to talk with high-risk employees face to face to help them develop a six-month intervention plan,” Ms. Ramey said. “After the physician sees them, I send out one of our nurses on a monthly basis to meet with the employees to make sure they adhere to the doctor’s recommendations. Then we test them again in six months.”
Free educational seminars taught by affiliated physicians, therapists and other professionals also are popular. Topics include men’s and women’s health and injury prevention for industrial athletes. Companies can also take advantage of WorkWise’s smoking cessation classes, which utilize free American Cancer Society materials; the employer only pays for the staff nurse’s time.
For employer-paid services, clients receive a consolidated invoice reflecting all billable activities on a monthly basis. Workers’ compensation is billed separately. The WorkWise staff reviews invoices before they are mailed to double-check accuracy and encourage prompt reimbursement. WorkWise utilizes the hospital’s Meditech software, (with some customization) as the foundation for its information and financial management functions.
Other Key Factors
Ms. Ramey, who has 28 years of experience in employee benefits management and occupational health marketing, said the hospital was losing local business to a larger hospital 30 miles away when she was hired 10 years ago to help turn things around. Since then, she has worked closely with hospital management to make sure the program remains sound.
“I told senior management when I was hired that it was going to be so important for departments within the hospital to know that they support the occupational health program and that they mean business,” she said. “When I set up the program, I hired people who were familiar with human resource functions, workers’ compensation, employer physicals and how to get results back in a timely manner. It is critical if you are starting a program to hire people who understand the employers’ perspective.”
In her PowerPoint presentation on How Important is Occupational Health to Your Organization? Ms. Ramey refers to RYAN Associates/National Association of Occupational Health Professionals’ market research that shows many hospitals and medical groups suffer from a lack of visibility that could be readily heightened through the provision of a well-defined occupational health program.
“A lot of employers are just confused about what to do. They need guidance,” she said. “It’s really just a matter of having someone sit down and help them figure things out.”
For programs in markets facing serious economic challenges, Ms. Ramey suggests re-emphasizing a one-on-one approach with current and prospective clients.
“The first thing I would do is identify larger employers in the area and talk with them, face to face,” she said. “I would ask them, ‘What we can do to help?’ I would let them tell me their story.
“I would try to bring as much knowledge to the table as possible to encourage them to do pre-placement testing. I would present scenarios to show them how serious the ramifications may be if they don’t perform screenings, and I would encourage them to seek external medical expertise if they don’t have a plant nurse.
“Even in a smaller market, there is always someone trying to take the business away from you or undercut your prices. The main thing is to let employers know you are state of the art with everything you do.”
