By Karen O’Hara
Every market has a white-collar population in need of occupational health services. The challenge is finding the best ways to tap into the business opportunity.
A good place to start is with an understanding of the white-collar workforce and health issues associated with conditions such as sedentary jobs, long hours on the computer, prolonged intellectual demands, and stress.
In the U.S., white-collar professionals and managers under age 65 comprise an estimated 40 percent of the workforce. The remainder includes a mix of white-collar and blue-collar occupations, according to March 2016 Census Bureau data analyzed by the Kaiser Family Foundation.
The distinction between blue-collar and white-collar is linked to the blue uniforms traditionally worn by men performing manual labor and the white button-down shirts worn by men in professional occupations. While clothing styles have evolved and women now comprise nearly half of the U.S. workforce, these labels remain in use.
At RYAN Associates’ 30th Annual National Conference on Providing Healthcare Services to Employers, four speakers addressed topics relevant to the white-collar workplace: ergonomics, concierge medicine, travel medicine, and population health management. The following features are highlights from their presentations and a related panel discussion.
ERGONOMICS
Topic:
Unique ergonomic challenges for the white-collar population: Uncovering the hidden causes of work-related injuries
Presenter:
Sheila Denman, Senior Vice President, ATI Worksite Solutions
Common causes of work-related injuries in the white-collar workplace include repetitive motion; slips, trips and falls; improper lifting and reaching; and being struck by moving objects. Ergonomic-related physical complaints such as backaches, neck, shoulder and wrist pain, and eye strain are more often caused by an improper workstation setup than the equipment itself. Sedentary work and performance demands also contribute to injury risk.
Ms. Denman, who specializes in the design of on-site injury prevention and performance improvement programs, offered these suggestions for occupational health programs that provide ergonomics consulting:
- Carefully observe employees at their workstations. Wait long enough for them to default to their typical posture.
- Pay attention to complaints such as arm and wrist pain, neck and shoulder tension, migraines, headaches, and jaw discomfort. Workstation adjustments may help provide relief.
- When seated, the employee’s back should be supported and feet firmly on the floor or a footrest. Shorter people tend to curl their feet on chair casters. Provide instruction on the chair’s adjustment features.
- Clear the workspace of clutter and personal items. Dual monitors should be evenly mounted and situated side by side.
- Train employees who travel or make service calls on safe lifting techniques. Wheeled bags should be pulled alongside the body, not behind it. Bags with shoulder straps should not be used to carry laptops, files, and other heavy materials. Also, consider the types of vehicles used for deliveries; it’s easier to manage a load carried in a vehicle with a hatchback door.
- Laptops typically have small keyboards that are not ergonomically designed for extended use. When necessary, it’s advisable to attach a mobile keyboard pad rather than type on the device itself.
- Recommend the use of a hands-free device for cell phones. Discourage constantly carrying the phone or resting it on the shoulder.
- Encourage routine eye checkups and appropriate vision care.
CONCIERGE MEDICINE
Topic:
Watershed or Myth: Executive Physicals Evolving to Concierge Medicine Practice
Presenter:
Randy Van Straten, Vice President, Business and Community Health, Bellin Health, Green Bay, WI
Market forces are changing the nature and demand for executive physicals, long a mainstay for companies taking steps to protect their investment in senior leadership. Bellin Health has leveraged its expertise by turning its successful executive health program into a concierge medical practice. The physician who originally won over executives by providing comprehensive physicals now owns the concierge practice and remains part of the system’s provider network. The practice employs a nurse and a receptionist.
Concierge medicine is an example of the nation’s ongoing evolution from “sick care” to a preventive healthcare delivery model. “Power is no longer predominantly in the hands of physicians, and technology is poised to replace the doctor-patient relationship,” Mr. Van Straten said. “Executive physicals were more popular 10 years ago. With equalization of leadership and benefits over time, we are now seeing business executives as well as business owners, retirees, and families in a concierge setting.”
Concierge medicine involves paying a fixed fee for access to a dedicated physician who caps patient enrollment and is housed in a high-end office suite. The model addresses access issues such as long waits for appointments and a lack of incentives for physicians to develop rapport and take extra time to educate patients about their health status and treatment options.
Concierge medicine appeals to senior executives because it is convenient and promotes the development of a close doctor-patient relationship, mutual trust, and respect. In turn, an affiliated health system such as Bellin Health can enjoy positive halo effects when it comes time for an appreciative executive’s organization to make decisions about health benefits and population health management service offerings.
Executives enrolled in the concierge program receive a day-long executive physical as part of their package. Components include a thorough review of medical records, a detailed discussion of health history, comprehensive lab testing and blood workup, a thorough physical exam, a nutrition and fitness assessment, and a personalized, comprehensive health report and medical record for the executive to take home. Services not covered under the fixed concierge fee of $3,000 per year for an individual or $7,000 for a family are balanced billed or sent to the executive’s insurer.
TRAVEL MEDICINE
Topic:
Travel Medicine: a Critical Piece of the Occupational Health Service Line
Presenter:
Michael Polich, M.S., MBA, FNP-BC, Clinical Quality Review Specialist and Nurse Practitioner, Cigna Onsite Health
Travel medicine primarily deals with disease prevention and health management of business, leisure, and adventure travelers who leave the U.S. to visit other countries. It requires knowledge of epidemiology, infectious diseases, environmental risks, and recommended safety and health precautions. Fee-for-service travel medicine can be a natural fit for an occupational health program or clinic, especially if it is already providing some vaccines and/or is located in a market with a significant percentage of companies that require international travel. Most of the services can be provided by a physician, nurse, nurse practitioner, physician assistant, or a combination of these roles.
“A good travel medicine program protects health and saves employers and the traveler time and money,” Mr. Polich said. “Infectious diseases acquired during travel create a tremendous burden in terms of quality of life, lost productivity and costs.”
Optimally, a pre-travel consultation occurs four to six months prior to departure. It is likely to include a review of health history, current medication use and previous travel outside the U.S. Other components include:
- recommended and required vaccinations for the destination • recommended and required medications
- advice on access to care if needed while traveling
- education on disease prevention, e.g., vector-borne, bloodborne, airborne, and sexually transmitted diseases, food and water safety, sun protection, traveler’s diarrhea, jet lag, and altitude sickness
It’s essential to take time to ensure that travelers understand the information provided and the need to consistently comply with instructions in order to protect their health while abroad.
Clinics that add travel medicine as a service offering typically need to expand supplies and provide access to vaccines for yellow fever, typhoid, Japanese encephalitis, hepatitis A and B, polio, as well as tetanus, meningitis, and varicella. To provide yellow fever vaccinations, providers must be certified by their state’s health agency.
Over the long term, travel medicine providers can expect to encounter some common concerns and challenges. Examples include travelers presenting a few days before their planned departure, demand for 24/7 telephonic consultations, vaccine shortages, and the need to stay abreast of global disease trends and international travel safety advisories. In some cases, a traveler may require a post-trip evaluation for a medical complaint that may or may not be connected to their trip. In addition, providers must be able to advise leisure and adventure travelers who may be inclined to skip recommendations or seek alternatives to reduce out-of-pocket expenses.
Mr. Polich refers providers to the following resources:
- American Society of Tropical Medicine and Hygiene: www.astmh.org
- Centers for Disease Control and Prevention Travelers’ Health: www.nc.cdc.gov/Travel
- International Society of Travel Medicine: www.istm.org
- Shoreland Travax subscription service for clinicians: www.shoreland.com/ services/travax/
- www.Wilderness-Medicine.com
- World Health Organization – International Travel and Health: www.who.int/ith/en/
Panel Discussion
At the conclusion of the white-collar course, Ms. Denman, Mr. Polich, and Mr. Van Straten participated in a panel discussion. The following is an edited transcript:
Q: How might a program best work with white-collar companies?
Ms. Denman: The white-collar population may work on computers eight to nine hours a day and then go home and get back on their computer (or other communication devices) for another two to three hours. They need interventions related to this lifestyle.
Mr. Polich: I agree. We need to place a special emphasis on repetitive motion hazards and musculoskeletal disorders; I see a lot of these diagnoses. Evaluation and education can be provided in person or through telemedicine in many different types of environments.
Mr. Van Straten: When you think of your program’s transition to becoming a well-being business, keep in mind that employees, especially those in the millennial generation, want a job with purpose. We are seeing more demand for volunteerism, gifting your talents, and working for a reason. We are doing some pilot projects and exploring ways to help facilitate those types of well-being activities for employees. It is really changing us as a health system.
Q: Looking ahead 10 years, what do you expect a package of employer-directed services will look like?
Mr. Van Straten: The package will be based on the total cost of care, not just for workplace-based services but for overall healthcare. We are already moving into risk-based agreements. We offer on-site services with an earn-up mode. For example, instead of getting $90 an hour for an on-site physical therapist, we will charge $50 an hour with the potential to earn up to $150 an hour based on measurable results, such as reducing the employer’s DART (Days Away, Restricted or Transferred) rate.
Ms. Denman: The package will be more prevention-oriented. One of the barriers today is that many employers pay their workers’ compensation insurance premium and don’t think about injuries walking out their door or the cost of an MRI because they never see the bill. Also, when preventive services are not covered they are seen as an added cost. We have to change that mindset. Just as we are asking employees to be more accountable with respect to the way they use personal health insurance, employers also have to become more accountable. If they were, then they would think twice about sending every injury they have out to a clinic and instead use that money for preventive services.
Mr. Polich: Travel medicine and telemedicine will be a big part of the package, partly due to growth in the remote workforce. Also, I believe ergonomics is underutilized; there will be a greater focus on ergonomics as well as providing good medicine.
Q: Do you believe that a special set of services should directed to executives?
Mr. Van Straten: There are people who think concierge medicine is just wrong. There are primary care physicians who don’t support it at all. But if we don’t do it, someone else will. So, my position is to provide it. It’s a great business model.
Mr. Polich: I believe in it, but it’s not easy to start something like that. You need a lot of assistance to make it work.
Ms. Denman: It requires leadership from the top. If leaders are not willing to display what they want employees to display, then they are not leading them. I believe that primary health on-site is a very real thing; it is the employees’ version of concierge medicine. It removes barriers and it gets people to their physician quicker. If we can engage people at the beginning of an episode we are going to turn it around in a much cheaper manner than if we wait for it to become full-blown and out of control. Occupational providers must be present and working on the floor in a facility. They cannot sit around in their office and work on total worker health.
POPULATION HEALTH
Topic:
Transforming Occupational Health to Population Health Solutions
Presenter:
Jodi Boldrighini, Director, Occupational and Employee Population Health Solutions, Yale New Haven Health System, New Haven, CT
The Yale New Haven Health System has taken aggressive steps to change internal perceptions of occupational health service offerings as a drain on resources to recognize employer-driven population health solutions as key contributors to the system’s sustainability.
The turnaround was essential to survival: The system’s multi-site delivery model was losing money. It lacked service standardization, was management-heavy, and had decentralized billing and collections. To address these and other issues, the health system retained a consultant to conduct external market research and recommend ways to repackage services. Local employers expressed a desire for engagement, improved worker productivity, reductions in lost work days, and restricted time and assistance with healthcare cost containment.
“We learned there was a huge opportunity for us to become a primary sales channel to employers for all specialties in the system and improve our own culture of employee safety and well-being,” Ms. Boldrighini said. “Primary care, wellness, specialty service lines such as physical therapy, and occupational health are all part of the total solution.”
A “universal business system design” was used to redefine leadership roles and responsibilities and create a single chain of command. Other steps included closing two clinic locations and consolidating services at others. By standardizing services and billing across all sites, the health system has been able to enter into preferred engagement contracts with key clients, dramatically improve collection rates, and reduce “cherry-picking” in the marketplace.
To date, the health system has achieved nearly $5 million in savings. Meanwhile, collaborative relationships with the health system’s wellness team and at-risk arrangements with employers who are interested in pursuing a value-based care model for working populations are being pilot-tested.
Karen O’Hara is Director, Marketing and Communications, at WorkCare, Inc., a national occupational health services company. She is the former Senior Vice President of RYAN Associates and Editor-in-Chief of VISIONS.
