By Isabelle Walker
Though not quite a discernable trend, the growing number of health systems that have opted to merge their occupational health and employee health programs are reaping rewards not only monetarily but also for the health status of their workers.
From Escondido, California to Frederick, Maryland, leading health system administrators are overcoming their reticence to change and jumping into the new era of blended occupational health and employee health programs. Feedback from the trenches indicates that initial challenges and hurdles tend to fade as the advantages of having cohesively blended workplace wellness and occupational health programs kick in.
Just ask Tim Ross, regional director of Working Well, a nine-year-old occupational health program and subsidiary of Northern Indiana’s Franciscan Alliance, or Glen Pugh, clinical manager at Palomar Corporate Health, a division of Palomar Health System in Escondido, California. They and others will tell you the benefits are ample and ongoing. In 2005, when the Franciscan Alliance decided to restructure by separating its network into regions, it peeled off and branded its occupational health program, naming it Working Well. For the purposes of efficiency, the health system decided the new Working Well program should absorb the employee health departments of its five Northern Indiana hospitals, making it the frontline provider of injury care, prior-to-hire exams, TB, and other mandatory health screenings, for roughly 7,000 employees. “As an occupational health program, you’re already providing most of the same services to your business community, so it’s an easy integration because there is really not a whole lot for your staff to learn other than a little more reporting,” said, Mr. Ross. The biggest challenge, Mr. Ross said, was probably the adjustment employees had to make as they were directed to off-campus Working Well clinics for care instead of going to in-house employee health departments. Meanwhile, four full-time employee health nurse positions were eliminated and knowledge gained through cross-training of clinic staff became a boon to the whole program.
Palomar Health, a public health system near San Diego, California, with two hospitals, two skilled nursing facilities, and two ambulatory health clinics, had $2.2 million in worker’s comp claims in 2002. Without a comprehensive employee health program or an occupational health program, there was no way the system could hedge against the risks associated with providing care in a busy hospital. So it created an employee health program and, shortly thereafter, Palomar Corporate Health was added. When the former was folded into the latter, Palomar Health became a client of its own corporate health department. Workers Worker’s comp claims dipped to $1.3 million the following year. This year, claims are trending in the neighborhood of $800,000, according to Russell Riehl, M.H.A., the program’s business manager. Anyone who incurs a work injury is referred to the occupational health program which provides exposure treatment, blood splatters, needled pricks, ergonomic evaluations, TB screening, prior-to-hire physicals, annual health evaluations, fit testing, and wellness, according to Glen Pugh, R.N., B.S.N., clinical manager, Palomar Corporate Health. The greatest blending challenge was the culture shift, said Mr. Pugh. Because Palomar Corporate Health manages the entire scope of the employee health program, workers were returned to work faster and seen by occupational health providers instead of, at times, their physicians. “Any change in the experience for the employee is going to be felt personally, and taken personally,” said Mr. Pugh. “When [the employees go] back to their departments, are they explaining or complaining? And how will their supervisor respond?” But Mr. Pugh said it was only a matter of time before Palomar employees recognized that the health outcomes were as good as they had ever been. “From my perspective, the culture began to shift after 18 months.” But how do organizations integrate their programs so that care remains top-notch while efficiencies are also achieved? This requires the use of metrics to gauge how well programs are doing. That means tracking many and various things––lost workdays, frequency, and severity of injuries, percentages of employees receiving mandated vaccinations, TB screens, and more. Palomar Corporate Health’s Mr. Riehl said his system uses metrics to gauge its performance. Percentage of injuries per full-time employee (FTE), the average cost per workers’ compensation claim, the number of claims per payroll, and claims filed vs. claims closed are some of them. Working Well tracks employee sick days and the type of illness workers are out with as well as flu vaccination rates, TB testing, and other compliance-related activities.
Dr. Bernie Ranchero, medical director of the blended occupational and employee health programs at Sarah Bush Lincoln Health System in Mattoon, IL, said his program also uses metrics to gauge performance. Because it has a robust wellness program, when employees participate, surveys allow for the confidential gaging of overall employee health metrics––blood pressure rates, tobacco use, BMI, and other measures. For example, since the health system began its formal smoking cessation program, there has been a 10% decline in the number of employees who smoke. Fifteen percent of employees have lost two BMI points in the past year. Between 70 and 80 percent of employees participate in the wellness programs, Dr. Ranchero said, a number that’s boosted by monetary and other kinds of incentives. However, to integrate successfully, programs need the support of top administrators, said Mr. Pugh.
“Employers want one thing—to trust that you want to take care of their employees and that you will do it well.”
Corporate Occupational Health Solutions, or CorpOHS, in Frederick, MD, is a subsidiary of Frederick Memorial Hospital. In operation for over 20 years, it has a strong return-to-work philosophy and does all the injury care and prior-to-hire exams for its parent hospital. “Our philosophy is to get people back to work whether it’s with restrictions, just so they are at work and not at home,” said David Bowman, senior operations manager at CorpOHS. “So the overall value to the system certainly would be on the workers’ compensation side. And that’s one of the metrics used by the health system to measure how we are doing.” Mr. Bowman said the hospital’s workers’ compensation claims are one of the lowest in Maryland.
Before taking over the injury care and prior-to-hire exams of medical center employees, hospital employees sought care in the employee wellness department of the hospital. After integrating, employees received care at CorpOHS’s two clinics. The closest is a few miles away. That, according to Mr. Bowman and clinic manager Jenny Morgan, was an adjustment for some. The upside was that the clinic’s providers were longtime Frederick Memorial staff—familiar faces. For CorpOHS the upside was that they had an additional revenue stream.
Another advantage comes from the opposite direction. Many businesses look to their occupational health provider for answers to all kinds of questions. They want to know what the program is doing for its workers and the staff of its affiliated hospital. An integrated program has ready answers. Kristina Adams, R.D., director of wellness at Sarah Bush Lincoln, said selling wellness to outside industries becomes that much easier when you’re providing it to your own workforce. “They realize this is what we do for our employees,” said Ms. Adams. “They know us, they trust us and they think, ‘If it’s good enough for your employees, it’s good enough for ours.’” In the beginning, Palomar Corporate Health found selling its services to the community a challenge. “Clinical care was not the problem,” said Mr. Riehl. “Marketing and selling our services was something we had no experience with.” So the program began publishing a monthly newsletter and providing clinic tours among other tactics. It now has close to 700 clients. “Employers want one thing,” said Mr. Riehl. “[And that is] to trust that you want to take care of their employees and that you will do it well.” The fact that these programs are also taking care of their own health system’s employees is a great selling point. “When we’re trying to sell our wellness [programs] to companies, they will ask ‘What are you guys doing for wellness?’ And we can say, ‘You know these are the things that we have,” said Mr. Ross.
Integrating Occupational and Employee Health will be the topic of course #5 at RYAN Associates’ 28th Annual National Conference with Dr. Stuart Levy and Kelly Nelson among the presenting faculty.
