By Anthony Vecchione
What will the field of occupational health look like 10 years down the road? Industry veterans are trying hard to unravel some of the most vexing unknowns so providers and managers can steer their ships to success.
In 2015, the American College of Occupational and Environmental Medicine (ACOEM) and Underwriters Laboratories (UL) convened a summit entitled: “Transforming Workplace Health and Safety Through Accountable Care Organizations and Patient-Centered Medical Homes: New Pathways for Employers.”
Data from the summit showed that Accountable Care Organizations (ACOs) and Patient-Centered Medical Homes (PCMH) have emerged as important new models for healthcare delivery. Summit contributors reported that a number of large, self-insured employers have adopted key principles of team-based, integrated healthcare, incorporating them into their workplace health and safety strategies. The size and influence of these companies have lifted these models to a new level of relevance––making them catalysts for the ongoing expansion of ACOs and PCMHs.
Due to the fact that they are large purchasers of health services with expertise in worker health and safety, population management, data collection, supplier management, and quality improvement, these large employers have the capacity to significantly impact the quality of healthcare delivery and outcomes by engaging and participating in ACO/PCMH initiatives. Who benefits from this strategy? According to summit experts, employees do. But, by accelerating healthcare transformation, so do the communities in which these companies do business.
A 2009 article published in the Journal of the American College of Occupational and Environmental Medicine entitled, “Health and Productivity as a Business Strategy,” revealed a growing body of evidence linking the health of the workforce and its productivity of the workforce.
Jay Himmelstein, M.D., M.P.H., chief health policy strategist, Center for Health Policy and Research, University of Massachusetts Medical School, said going forward, healthcare system trends will include the triple aim of better care, better health, and lower costs.
“What has to happen for occupational health is to prepare yourself to take advantage and be ready to integrate your programs with these mega-trends in the healthcare system,” said Dr. Himmelstein.
The scheduled keynote speaker at Ryan Associates’ 30th Annual National Conference in October, Dr. Himmelstein said the following would be key areas of interest for providers:
- New payment systems: Ever-rising costs leading to attempts to bend the cost curve, including value-based payments; increased employee cost sharing, and high deductible health plans.
- New delivery systems (ACOs and PCMHs): Recognition of population health and the impact of the ‘social determinants’ of health, including non-medical conditions that impact health outcomes such as poverty, homelessness, inadequate nutrition, and poor education. The a need for providers and health systems to be more proactive if they are to truly provide value.
- Getting patients to be fully involved/fully engaged in their own healthcare: To understand and comply with evidence-based treatments and to do what they can to improve their health status in order to achieve the triple aim of high-quality care, improved outcomes, and lower costs.
How will all this impact occupational health programs? Healthcare delivery in the workplace [will gradually be recognized as] a high value, low-cost service and an untapped opportunity to improve efficiency and lower costs of non-work-related health services, said Dr. Himmelstein. In addition, new payment systems will encourage the delivery of clinical and preventive services in workplaces. There will be integration with ACOs, and identification and outreach to employees with complex, high-cost chronic health conditions.
He added that in the future, occupational medicine should focus on “opportunities for prevention and wellness programs to lower costs, including aligning incentives for healthy lifestyles in and outside of work.”
WORKPLACE OF THE FUTURE
What other notable trends are occupational health experts predicting?
Frank Leone, M.B.A., M.P.H., a senior advisor at RYAN Associates, sees a greater integration of behavioral health/mental health services into the broader occupational health spectrum of services as the next frontier.
“Occupational health practitioners place considerable emphasis on getting an employee back to work as safely [and quickly] as possible. But a few saved workdays pale in comparison to the toll borne by unproductive workers beset by mental health issues such as depression. If we as an industry are going to make a genuine impact, we need to shift much of our focus to the mental health side,” Mr. Leone said.
Industry insiders also assert that infectious diseases and opioid addiction should be on the occupational health radar screen going forward.
Thomas Winters, M.D., president and chief medical officer of Occupational & Environmental Health Network (OEHN), based in Marlborough, MA., said that occupational health clinicians need to maintain a high level of understanding of emerging infectious diseases. “We have roles at corporate, community, and hospital levels to inform and educate the workforce on risks of travel, risks in our communities, and risks in outdoor activities,” Dr. Winters said.
This entails protecting workers from vectors of diseases such as Zika and other mosquito-borne diseases that are moving north, Dr. Winters said.
The National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) reports that the month of May saw an uptick in Zika activities – especially in the Centers for Disease Control and Prevention’s (CDC) efforts to prepare for the Olympics in Brazil this August.
Dr. Winters also warned about the growing opioid epidemic. Deaths from opioids, which often begin with a benign prescription, now exceed deaths from motor vehicle accidents. “We in occupational health have been aware of this problem for years. We have been educating residents in occupational health/preventive medicine programs on these risks,” said Dr. Winters. “These are doctors caring for the majority of the workforce in the US. We teach a short course on the use of opioids for acute traumatic injuries if needed and that opioids are ineffective for chronic pain.”
Dr. Winters and his colleagues have been advising insurers and engaging in peer-to-peer communication with outlier physicians, teaching them that if their patients are on > 120 morphine equivalent doses of opioids – there is an 8 X risk of morbidity (overdosing) and death. “If they also prescribe anti-anxiety meds and sedatives, this risk increases,” Dr. Winters said. According to the National Institute on Drug Abuse, from 2001 to 2014, there was a 3.4-fold increase in the total number of deaths from opioid pain relievers
In the mental health area, Dr. Winters said pharma isn’t the answer for mental health conditions. “Having a functional job, a supportive work environment with supportive management people is [a more effective] answer. I think in occupational health, we need to be intimately involved in those initiatives in the companies where we work.”
Additional findings from the ACOEM/UL summit revealed that:
- The workplace should be used as a model for the successful implementation of ACO/PCMH concepts.
- Sectors with a stake in healthcare should become better aligned with each other—and that includes the employer community.
- The workplace should be an essential element, along with communities and homes, in an integrated system of health anchored by ACO/PCMH concepts.
- Summit participants asserted that there should be an expansion of the ACO and PCMH concepts in the employer community.
Occupational and environmental medicine physicians’ expertise in maintenance and restoration of function as a health outcome, the use of business-relevant health and productivity outcomes, the use of evidence-based guidelines, and the ability to demonstrate return on investment gained from workplace programs are all of great benefit to the ACO and PCMH strategies.
Despite the challenges ahead, Dr. Winters said he is optimistic about the future of occupational health. “We can influence the future in a positive way. We’re not the decision makers but we can be the drivers and the motivators and the instigators behind decisions. The more you can get the ear of a senior leader and push an agenda that’s proactive towards benefiting their workforce and improving the work environment, the more you will be doing your part.”
