By Anthony Vecchione
The concept of white-collar occupational health is nothing new. Prudential Financial has been taking care of its employees at on-site clinics for 101 years.
While many companies have occupational health departments, occupational health is usually associated with traditional so-called blue-collar trades such as mining, manufacturing, and construction. Occupational medicine in that context evokes images of specific on-the-job injuries linked to safety issues.
When it comes to white-collar occupational health, the definition shifts from work-related injuries to prevention and, more recently, primary care. Keeping highly paid C-suite executives healthy can be an expensive undertaking, but for a large pharmaceutical or financial services company, it is an investment worth making.
PROMOTING A CULTURE OF HEALTH
According to the National Business Group on Health (NBGH), large employers have been showing a greater interest in on-site health centers. In the last 10 years, there has been an increase in the number of companies that have expanded their offerings to include services such as flu shots, preventive screenings, and care management for chronic conditions.
“They are looking beyond just occupational medicine . . . The core is still occupational health and medicine, but it is more oriented toward having a culture of health in the whole company,” said Helen Darling, M.A., NBGH president and CEO.
Ms. Darling noted that occupational medicine is placing greater emphasis on preventive and primary care. “Employers are beginning to see the employee and in some instances family members as the human asset that they are, and they want to do everything they can. Occupational medicine, and this expanded role, have come into the mainstream of the corporation.”
The three most common executive health program models are: in-house, clinic-based, and the single-physician model. In-house programs, in which all services are provided on-site, have cost advantages but can be limited by the unavailability of many secondary and tertiary medical services. Clinic-based programs typically offer more comprehensive services. The single-physician model usually involves an internist in the community who contracts with smaller local businesses to provide a scaled-down executive-health program.
While some large corporations, such as 3M, offer an in-house model, many prefer the clinic-based model. The Mayo Clinic has one of the largest, most successful executive health programs in the nation with locations in.
Rochester, Minn, Jacksonville, Fla., and Scottsdale, Ariz. The Scottsdale program alone sees over 3,000 executives a year and provides comprehensive services ranging from cancer screenings to coronary artery disease detection studies to diet and exercise management. One of the advantages of the Mayo program is that patients have access to specialists for a referral. We can deal with pretty much anything that comes up, and most problems can be addressed immediately,” said Robert R. Orford, M.D., a senior consultant with Mayo’s Scottsdale executive program.
Dr. Orford said Mayo’s Executive Health Program, which began in the 1940s, focuses on c-suite and other senior executives, whose examinations are covered by their corporations, but it also includes other executives and professionals including physicians, lawyers, and accountants.
“About 60 percent of patients in our program are individual executives. They will usually use both insurance coverage and some out of their own resources to cover the cost of their exam,” said Dr. Orford.
How valuable and successful are large clinic-based executive health programs? “Extremely valuable,” said Dr. Orford. “We are finding melanomas, prostate, breast, and other cancers, as well as heart disease and many other conditions.” Dr. Orford pointed out that Mayo’s executive health program also focuses on individualized medicine, which is different from screening in that it addresses issues of concern, or specific to, the individual patient.
K. Andrew Crighton, M.D., vice president and chief medical officer at Prudential Financial, said occupational medicine is defined more broadly today. “Within our Health and Wellness Group, we have on-site clinics where they do wellness activities and a lot of the biometrics. They look [for] people with certain disease states and start working with them on an individual basis.”
Dr. Crighton added that Prudential also offers life coaching, on-site fitness centers, and an industrial hygienist who focuses on ergonomics and other services specific to the white-collar environment.
“It’s an easy one-stop-shop. We are also there as a resource for them if they have any questions. We are a bridge between the employee and the medical system; we are not there to replace but to bridge it and make it easy for them,” said Dr. Crighton.
Prudential Financial has on-site clinics at most of its larger sites and about 55-60 percent of its employees have access to one of the clinics. Dr. Crighton said the company also does outreach to secondary sites where they do screenings three to four times per year as well as provide webinars. “As we are trying to reach beyond the walls we have moved to webinars rather than just the regular lunch and learns.”
In the area of longitudinal medicine, Dr. Crighton said Prudential partners with its benefits organization and looks at the overlap. “We are trying to identify employees or dependents at the point of need, so we have a lot of relationships with other vendors.” Dr. Crighton said the company uses a vendor for its Health Risk Assessment (HRA) and other health information. “We actually use WebMD for that because that gives us broader outreach. We are catching people without disease and focusing on the health risk.”
Randy Van Straten, vice president of Business and Personal Health Solutions at Bellin Health in Green Bay, Wis., contends that occupational health is no longer just about the workplace and is now focusing on the overall health of employees.
“Our strategy came out of traditional occupational health, but we started working with our own employees. We were facing a 30 percent increase in costs one year so we started working with our health plan design, incentivizing our employees to take health risk appraisals,” said Mr Van Straten.
The goal of the Bellin Health executive health program, according to Mr. Van Straten, is to get people to participate in their health, to focus on outcomes, and to work on removing barriers to care, cost, and convenience.
Mr. Van Straten noted that Bellin, an integrated healthcare delivery system that includes an acute care hospital, operates three occupational health clinics and works with different-sized employers. “We configure services for the specific needs of their population and deliver them onsite to help them induce participation, outcomes, and engagement with health and to ultimately reduce costs and improve health.”
According to Mr. Van Straten, the business has grown well beyond its occupational health department. “We have more business growing out of overall general health with bringing health to the workplace than we do [from] the traditional occupational health.”
Bellin Health has 74 sites with on-site providers ranging from nurses to doctors, to physical therapists, to dietitians as well as fully staffed fitness centers. Among Bellin’s employer clients are The Green Bay Packers, Associated Bank, and Fincantieri Marine Group––a Wisconsin-based company that builds ships for the U.S. Navy.
“We bring healthcare close to the workplace and work with the employer to remove the barrier of cost with the convenience of having it right at work,” Mr. Van Straten said.
CAN EXECUTIVE HEALTH PROGRAMS BE REVENUE CENTERS?
“We sell services directly to the company and then it is a direct deal where we are carving out the health plan,” said Mr. Van Straten. “Basically we are selling our services by the hour instead of by the piece.” When asked how he would measure Prudential’s occupational health program in terms of return on investment, Dr. Crighton commented:
“We view success in terms of health risk reduction. We also look at the impact our programs have on medical costs. But the main focus of our efforts is really centered on enhancing the overall health and performance of our employees.”
WHITE-COLLAR JOBS HAVE RISKS TOO
Although white-collar occupational medicine is focused on prevention, primary care, and health maintenance, white-collar employees are not immune to workplace injury.
According to the Bureau of Labor Statistics, private-industry employers reported almost 3 million nonfatal work-related injuries and illnesses in both white and blue-collar settings in 2011, resulting in an incidence rate of 3.5 cases per 100 equivalent full-time workers.
At the Palo Alto Medical Foundation, Gary Fujimoto, M.D., supervises a research staff working with concentrated H.I.V. and S.A.R.S. (Severe Acute Respiratory Syndrome) viruses and with primates carrying an unusual virus called B Virus that can be lethal. “Most of my work is supporting researchers working with some of these agents,” said Dr. Fujimoto, who is an occupational medical consultant and adjunct associate clinical professor of medicine at Stanford University.
“Most of the people I deal with are Ph. D.s, physicians, or research staff who are handling these agents. These are highly educated employees and leading research experts.” While executive health screenings are at the core of most large corporate occupational health programs, travel medicine and in some cases, concierge medicine, is frequently included in the mix.
TRAVEL MEDICINE
In addition to his duties in dealing with infectious diseases, Dr. Fujimoto runs the travel medicine clinic at the Palo Alto Medical Foundation, seeing hundreds of travelers each month. Many of them work on research projects or are high-tech employees at companies such as Apple and Google.
“Depending on where they are traveling, we want to prepare them so that they know what to do if they get sick. We vaccinate them for diseases that are present in the country they are planning to visit, such as Yellow Fever if they are traveling to South America or Africa,” said Dr. Fujimoto.
CONCIERGE VS. EXECUTIVE HEALTH PROGRAMS
Concierge medicine has been around since the late 1990s. While there is an overlap between executive health, concierge, and travel medicine, according to industry experts they are not really sub-categories of white-collar or executive health. But there is no denying that some level of competition exists.
For example, if an executive is part of a concierge practice, they might tell their company that they do not need an executive physical through an executive health program. “Both [models] are competing for individuals who have relatively high incomes,” said Steve St. Clair, M.D., medical director of Northeast Occupational Medicine Services in Concord, N.C., a program that provides basic occupational medicine services in the region as well as a concierge program. “Whether the concierge model wins out or the executive physical wins out, I think there will be a tension between those two models,” said Dr. St. Clair.
IMPACT OF THE AFFORDABLE HEALTHCARE ACT
As the Affordable Healthcare Act gets ready to kick in next year, white-collar occupational health experts have mixed reviews on how it will impact executive health programs. “I think there will be various impacts and it will be relevant,” said Prudential’s Dr. Crighton. He added that in Massachusetts when more people had health insurance, physicians became so overwhelmed there was backup in the system.
“In our risk analysis, we are looking at this and think we will see more people coming to visit the clinic because we think broader access may be a problem. We do not know if that will be fixed over several years, but we see that as a potential in driving people to on-site clinics.” Dr. St. Clair said that because of the level of income of the individuals who take part in executive health programs, he doesn’t see the ACA having much of an impact. “These are not individuals who don’t have health insurance.”
THE FUTURE OF WHITE-COLLAR OCCUPATIONAL MEDICINE
Will occupational health programs grow over the next several years, and how will economic forces impact growth and expansion? The NBGH’s Ms. Darling said a downturn in the economy could have both a positive and a negative effect on occupational health programs.
“You see companies pulling back. Maybe they wanted to open two health centers but when the economy went down, they could not add a lot of new things.” On the other hand, layoffs and retirements result in unfilled positions at many companies, and as a result, companies have to do more with less. “Being healthy, fit, and resilient is key, and when you have fewer people, whatever the tasks are, you need everybody to be fit for duty.”
Dr. St. Clair believes there is a lot of uncertainty with regard to executive health programs and it will depend largely on the individual organization. One factor that can impact the fate of an executive health program is a merger or a buyout. For example, company A may have a certain policy in place and gets acquired by company B which has a different occupational medicine/executive health policy.
