Timing It Right to Make a Lasting Contribution


Occupational health professionals have a significant opportunity to contribute to the nation’s health, says Emily Friedman, an independent health policy and ethics analyst. However, it will require perseverance.

Ms. Friedman cited a number of trends affecting the provision of health care services to employers during a keynote presentation on Changes, Chances and Challenges: Occupational Health’s Evolving Role in an Era of Health Reform at RYAN Associates’ 2012 national conference in Chicago.

As the country adjusts to life under the Affordable Care Act, she said occupational health interventions could produce remarkable results such as:

  • A healthier workforce and general population
  • Greater productivity and competitiveness
  • Finally, true “compression of morbidity”
  • Healthy aging as a reality
  • Less discrimination against the chronically ill and disabled
  • Concepts of “fault” and blaming the victim losing their punch
  • Truly replicable models

To achieve these ambitious goals, occupational health professionals need to help employers respond with sensitivity to diversity, aging and disability in the workforce, and take advantage of advances in information technology and medicine.

“Good health, whenever possible, is a human right. It’s a privilege to work in such a way that you can help people achieve it,” said Ms. Friedman, a prolific writer, adjunct assistant professor at the Boston University School of Public Health, and honorary life member of the American Hospital Association and the American Medical Association. “It’s not going to happen overnight, but it will happen.”


The Affordable Care Act contains a number of provisions salient to employers, Ms. Friedman said. They include a tax credit for smaller companies, the availability by 2014 of state-run or federally operated health insurance exchanges and penalties starting at $2,000 per worker on employers with more than 50 employees who do not provide affordable insurance coverage.

“This is really going to be interesting: there is a guessing game as to whether large companies will opt to take the penalty,” Ms. Friedman said. “But as long as you configure your marketing in accordance with certain goals, you should be able to navigate these white waters.”

In the midst of this uncertainty, two things are certain: the U.S. population is aging and it is becoming more culturally diverse. In addition, the U.S. census found nearly 20 percent of the U.S. population has a disability; 21 percent of disabled adults age 21 to 65 are employed, and a subset of that group (28 percent) are severely disabled.

Better educated consumers are another factor influencing the delivery of occupational health services, she said. For example, both employers and patients are asking more questions about medications and treatment recommendations. “This is a long-term trend that can lead to a healthy partnership, and if not, could lead to all-out war,” Ms. Friedman predicted.

Advances in information technology and medicine also are rapidly changing the face of health care. “I am a real fan of IT,” Ms. Friedman said. She described e-prescribing as a “godsend,” particularly for homebound patients, and the advent of electronic medical records as a benefit for all health care consumers, especially in the event of an emergency. Advances in understanding of nano-technology, genetics, genomic medicine, and customized drugs hold considerable promise, she added, although they are costly and require monitoring to prevent misuse.

“While it may not seem like it,” she said, wellness is another area that represents a chance for occupational health professionals to support employers, employees, and the nation: “Whatever you can do to prevent chronic illness saves money for all of us. Boy do we need it…the cost curve just keeps climbing.”

Projections suggest the average health care cost per person is on track to become higher than the poverty level for a single individual. “If we do not get costs under control, we will price ourselves out of the market and no one will be able to afford anything,” she cautioned. Unevenly distributed costs, with 50 percent of spending attributed to just 5 percent of the population, are added cause for concern.


According to Ms. Friedman, other noteworthy emerging issues include:

Accountable Care Organizations: “I am extremely cynical about ACOs… Having electronic medical records does not make you the Mayo Clinic. However, there are going to be a lot of ACOs coming out and hopefully they are going to be a fertile area for your efforts because they are designed to provide a continuum of care for all levels of disease,” she told the audience of occupational health professionals.

Recasting of primary care: “The fact is we don’t have enough primary care physicians, so other types of practitioners are stepping in: nurses, physician assistants, nurse practitioners, pharmacists…”

Expanded scope of service: Occupational health providers can take advantage of their understanding of health needs in niche populations. For example, inmates in correctional institutions and Medicaid recipients represent under-served populations in need of intervention. There also are opportunities for triage to ensure true emergencies are treated as such and non-emergent cases also are treated appropriately from the start, she said.

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