Occupational Health Forecast: Be Prepared for Changing Patterns

By Karen O’Hara

The start of a new year is an auspicious time to chart a course for an innovative occupational health delivery model based on experience, reasonable forecasts and willingness to accept a certain degree of risk.

The following predictions from industry experts provide insights to help organizations adapt to the changing landscape in 2016 and beyond.

ACCOUNTABILITY

Dale Bugay, Executive Director, Occupational Accountable Care LLC, a cooperative offering guidance to employers, providers, and payers to improve the health and productivity of employed populations, based in Columbus, Ohio

Mr. Bugay has an extensive track record in occupational health and risk management services. In his latest endeavor, “accountability” is his watchword. He envisions the integration of risk management and occupational health solutions through the development of cooperative agreements among providers, employers, and claims administrators. His primary objective is to “establish an accountable care relationship with employers and payers that documents quality improvement in the health and productivity of employed populations.”

Optimally, he would like to see occupational health programs act as population health guardians and care coordinators. While he reports incremental progress, he believes a makeover is required.

The following summarizes some of the predictions Mr. Bugay made during a presentation at RYAN Associates’ October 2015 national conference on Providing Healthcare Services to Employers:

1. Customer satisfaction ratings, rather than patient satisfaction scores, will be key drivers of performance incentives.
2. Participating employers will no longer have the option of holding out for full duty without job modifications. Safe return to work following an injury or illness, with or without accommodations, will be an essential component of accountable care programs.
3. Occupational health professionals will become much more engaged with employers’ risk management and cost control programs. Consequently, leading providers will emerge in most markets, surpassing those who are perceived as “just another provider in the network.”
4. Payers will start to recognize occupational health programs for providing quality, cost-effective injury management services. In many jurisdictions, payers take credit for cost containment because they are handling the claims.
5. Occupational health providers will be expected to take more ownership across the care continuum. This will require improved tracking of related activities such as diagnostic testing, referrals to specialists, and case management. “If occupational health providers’ contributions to health systems as a whole are only assessed on the basis of direct revenue and patient volumes, that is primary care, not accountable care,” Mr. Bugay said.
6. Advances in information technology will give providers access to medical and disability cost data to support comprehensive case management and reimbursement for care coordination. (For example, in Ohio, providers receive 115 percent of the fee schedule to coordinate care. In Washington state, providers receive $42 per claim to manage care.)
7. Wellness and personal health services will be blended, not segregated, and occupational health will occupy a bigger slice of the total workforce health management pie.

TAKING IT TO THE WORKPLACE

Peter P. Greaney, M.D., President, CEO and Chief Medical Officer, WorkCare, Inc., a national company specializing in worker protection and workforce health management, based in Anaheim, Calif.

Dr. Greaney, an occupational medicine physician, uses this example to illustrate how prognosticating can be a tricky business: In an interview with Inc. magazine in the early ’80s, he was asked about the future of workplace drug screening. At the time, he thought “drug screening will never fly.” Today it is a commodity occupational health programs are obliged to offer client companies.

Sometimes there are unforeseen game changers, he noted. For example, in 1988, as part of the war on drugs, President Reagan signed an executive order that led to legislation requiring federal employees and some contractors to be tested for illicit substances. Private employers followed suit. Search-and-seizure protections also were relaxed during the Reagan administration.

The following are among the predictions Dr. Greaney made during a presentation at RYAN Associates’ 2015 national conference in Chicago:

1. Keeping workers fit and productive is paramount to success. Therefore, it is reasonable to conclude that 24-hour telephonic triage, telehealth services using mobile devices, and on-site clinics with immediate care capabilities will continue to gain traction in the marketplace. Using Uber-like apps to redeploy medical providers and drones to deliver equipment where the need is greatest are also likely scenarios.
2. To help address the nation’s shortage of occupational health nurses and physicians, employers will seek assistance from providers to find qualified on-site personnel such as paramedics and athletic trainers.
3. Reimbursement models will be changed to reward clinicians who effectively manage work-related injuries and return to work.
4. Regulated companies with significant exposure risk, multiple locations, and aging workers will rely on occupational health professionals to establish exposure baselines upon hire, perform medical monitoring for the duration of employment, and remain involved in surveillance post-employment.
5. Rising costs associated with mental health issues, coupled with ineffective employee assistance programs, will drive requests for a broader range of worksite-based psychosocial services. Providers will be expected to clearly demonstrate the value of an employer’s investment in these types of services.
6. Similarly, opioid medication and medical marijuana use in the working population are problematic for employers. Occupational health providers will be expected to assess potential physical and mental impairment in connection with the use of medications and offer guidance on reasonable accommodations and interventions.
7. Paid family and medical leave will become the norm. This is already happening to some extent. President Obama supports paid leave for federal employees and contractors. Meanwhile, the proposed Family and Medical Insurance Leave Act (FAMILY Act) would entitle U.S. workers to paid leave – in essence expanding provisions of the Family and Medical Leave Act (FMLA) that allow workers to take up to 12 weeks of unpaid, job-protected leave.

However, Dr. Greaney said, there is a caveat: “Unless we have participation from the consumer, we won’t see any dramatic changes in the healthcare landscape. They have to have skin in the game. Otherwise, they will continue to consume, consume, consume. We also need to get the message to kids before they develop (unhealthy) behaviors.”

POPULATION HEALTH MANAGEMENT

Randy Van Straten, Vice President, Bellin Health, a health system based in Green Bay, Wis.

Since 2000, Mr. Van Straten has focused on business development at Bellin Health through the provision of progressive population health management programs. At RYAN Associates’ annual national conference, he explained why he believes occupational health providers must transition from purveyors of discrete service offerings to total health delivery models in the coming years.

Among his predictions:

1. Longer-term pay for performance or shared savings guarantees will be applied to wellness programs and on-site clinics. For example, employers may be guaranteed measurable improvements in health risk assessment scores over a three-year period in exchange for the provider putting reimbursement for health coaching services at risk. Or, an employer may be eligible for compensation if an on-site clinic operated by a contractor does not reduce the company’s insurance costs for a specified period of time; if savings are achieved, the contractor receives a percentage of the savings.
2. To be cost-effective, on-site clinic hours will need to be better aligned with workers’ hours, for instance, split shifts, 24-hour operations and work in the field or remote locations. This will require programs to hire and strategically assign staff before a contract for on-site services is signed.
3. The ability to demonstrate a deep understanding of the population being served will help local providers compete with national and regional vendors. For example, Bellin helps employers analyze specific workforce health risks and develop plans to better manage costly co-morbid conditions among individual workers in the health system’s service area.
4. The total health management model will succeed in organizations in which leaders establish a foundation for acceptance. Occupational health will be an integral part of the overall model when it is perceived as providing the right care, at the right time, and at the right cost. Key components may include 24/7 nurse triage, scheduled appointments and managed referrals.
5. Occupational health providers can not function as an island. Moving forward, they must partner with insurers, third-party administrators, brokers, claims adjusters, case managers and other stakeholders.

“We need to offer employers more help with getting and keeping employees, fast-tracking their training, and ensuring they are fit for their job. I see this as an issue we need to address as a nation,” Mr. Van Straten said.

THE BIG PICTURE 

Arthur M. Southam, M.D., M.B.A., M.P.H, Executive Vice President, Health Plan Operations, Kaiser Foundation Health Plan, Inc., and Kaiser Foundation Hospitals

Dr. Southam has national responsibility for Kaiser Health Plan marketing, sales, service, and administrative activities. Kaiser Permanente is recognized as one of the nation’s leading healthcare providers and not-for-profit health plans. It serves more than 10 million members and delivers approximately $50 billion a year in health services in eight states and the District of Columbia.

Dr. Southam brings a high-level view to the discourse about the future of U.S. healthcare delivery. While it has been said before, he believes the message bears repeating: prevention is the key. 

“We are a very medically oriented society,” he said during his keynote speech at the November 2015 Workers’ Compensation and Disability Conference & Expo. “Realizing that the current medical model won’t work is one of the most important advances we need to make in terms of social and cultural awareness in America.” 

Studies show:

• Personal behavior drives the need for medical care 40 percent of the time.
• Genetics and family history dictate the need for care 30 percent of the time.
• Environmental and social factors such as income and level of education influence the need for medical care 20 percent of the time.

“Why do we spend so much money on medical care and so much less on social services?” he asks. “We do the opposite of what many other countries do….some food for thought.” According to Dr. Southam, in the future:

1. Many healthcare encounters will be enhanced by telehealth functionality.
2. Employers will find ways to make it easier for employees to be active during the workday. “Improving the walk-ability of our workforce is one of the highest-yield things we can do,” he said, noting that sedentary lifestyles contribute to costly, disabling conditions including depression, dementia, stroke, obesity, and osteoporosis.
3. Worksite-based and freestanding occupational clinics will be part of the movement to ensure safe, timely, efficient, patient-centered care.
4. Mechanisms will be developed to connect people, departments, and organizations that operate in silos. This will benefit all healthcare consumers.
5. Coding will be updated to reflect advances in population health management. However, there is a long way to go.
6. Extraordinary advances in healthcare technology and medicine justifiably capture attention because they save lives. The next generation of leaders will be challenged to redistribute resources with the following issues in mind:

• Waste in systems and organizations
• Disparities in care quality based on location, patient demographics, income, ethnicity and other factors
• Preventable medical errors
• Management of chronic conditions that are the leading causes of morbidity, mortality and work absence
• Financial incentives that reward quality, care coordination and team-based care across functional disciplines
• Incentives for patient engagement and behavior change
• Information technology and knowledge management for good decision-making
• Broader use of electronic medical records, interoperability, and quality metrics
• Performance transparency and patient privacy

“One of the most important recent advances in healthcare is the smartphone,” Dr. Southam said. “Thousands of healthcare-related apps are already available. Further advances will take much of medical care out of the clinic or doctor’s office and put it in your home, your workplace or your pocket.” Web-based applications and mobile devices that facilitate access to personal health information, medical records, and individual providers allow for democratization in access. “It’s quite transformational,” he said.