An Entreaty to Demonstrate the Business Case

An American Industrial Hygiene Association (AIHA) white paper containing recommendations on a proposed federal Injury and Illness Prevention Program contains some valuable insights on establishing the business case for occupational health and safety interventions.

OSHA Director David Michaels says the prevention program is the Occupational Safety and Health Administration’s top regulatory priority. In its FY 2011 budget request, the Department of Labor has designated $583 million for OSHA, including $2.4 million for prevention program development.

The AIHA’s recommendations to OSHA are taken in part from its Value Strategy Manual. The manual features findings from a 2008 study of how Fortune 500 companies determine the value of contributions by occupational health and safety professionals, and it presents a solid framework for worker protection.

The AIHA Value Strategy promotes a comprehensive process in which occupational hygienists align risk management with business objectives – similar to what occupational health programs need to do to demonstrate the value of their interventions to client companies and other stakeholders.

The process incorporates the following steps:

1. Identify business objectives and hazards.
2. Evaluate and prioritize value opportunities.
3. Assess risk reduction.
4. Select approach to establish the value proposition.
5. Identify changes and assess impacts.
6. Document and present the value proposition.

In the third critical step, industrial hygienists identify actual or predicted risk reduction(s) associated with the implementation of a program, activity or intervention. The process includes pre- and post-intervention baseline risk assessment.

In a subsequent step, data (cost, performance, quality) are analyzed to determine whether the value proposition is best made using a qualitative or quantitative approach, or a combination of both.

According to the white paper: 

“Ample anecdotal and case study data demonstrate that a systematic approach to OHS management is cost-effective. Many AIHA members and other OHS professionals have demonstrated this in their companies and practice. A large benefit is commonly observed in lower workers’ compensation costs, which in some cases can be significant. Improved productivity and quality are also associated with implementation of these programs.”

Both the white paper and the Value Strategy report reference a number of related studies that are worth checking out. In addition, resources for conducting the risk assessment are contained in an AIHA publication, A Strategy for Assessing and Managing Occupational Exposures, 3rd Edition, and in the American National Standard Institute/American Industrial Hygiene Association Z10-2005, Occupational Health and Safety Management System.

As the AIHA notes: “Imagine what could happen when 12,000 IH experts begin applying this strategy to demonstrate the powerful impact the profession can have on business! We often talk about wanting our profession to be a household name. Now we have the strategy to make that happen. These results are a beginning, not an end.”

Occupational health professionals can learn from this challenge. They must strive to re-affirm their own value proposition in order to best serve clients and patients and have an influential voice in the development of OSHA’s proposed Injury and Illness Prevention Program.

Urgent Care-Occupational Medicine Mixup: What Do You Think?

Robert L Broghammer M.D., M.B.A., M.P.H., of Allen Occupational Health, a hospital-affiliated program in Waterloo, IA, writes us to express dismay about RYAN Associates' plans for an April seminar on Integrating Urgent Care and Occupational Health Services:

"I realize this is a ‘trend’ currently, especially with Concentra, but I must vehemently disagree that the two are complementary let alone easily integrated. While it is true that much of what we do has an ‘urgent’ basis (i.e. lacerations, traumas, chemical exposures, etc.), Occupational Medicine is a distinct and separate discipline with its own ACGME-approved post-graduate medical training programs and separate board certification process.  

"As you know, occupational medicine training focuses on toxicology, epidemiology, statistical analysis, orthopedics, surveillance screening, impairment and disability, wellness, and a host of other specific areas dedicated to the care of workers and their companies. Urgent care is nothing more than a descriptor for a clinic that will see you ASAP for a perceived medical problem. There is no specific knowledge base, even rudimentary, for urgent care providers who may provide services for injured workers covered by the worker’s compensation system or for the myriad of other occupational specific issues that need to be addressed and taken care of.

"Urgent care providers may have extremely diverse backgrounds and there is no formal standardization of training to practice in an urgent care setting – one simply needs a license and a pulse. Family practitioners, internists, pediatricians, physician’s assistants, nurse practitioners, general surgeons, and obstetricians are just a few of the disciplines that I know of personally that have/do practice in urgent care settings.  Likewise, occupational medicine providers, such as myself, have very little or no training in the variety of medical problems that may present to an urgent care center which have no relationship to work. Imagine an infant presenting with a fever versus a normally healthy worker. The differential diagnosis for the two is vastly different. For instance, the worker may have metal fume fever but it is highly unlikely the infant does.

"The integration of the two separate and distinct services will only serve to confuse the clients and dilute the value of providing specific occupational medicine services. The trend, in my opinion, is nothing more than attempting to squeeze a couple extra bucks out of clinics by short-sighted administrators.  Not one of my colleagues who I trained with and who are board certified in Occupational and Environmental Medicine would consider working in such a clinic long-term."

RYAN Associates' President and CEO Frank Leone responds:

"I don't think anyone is saying that it is a wise idea for a clinician to do both occupational medicine and urgent care. Yet they are not that different. The larger issue is economic; blended clinics offer a vast array of economies of scale (staffing, operations, shared equipment and diagnostic tools, sales and marketing, etc.) which not only makes them advisable in the economic climate, but often essential."

Donna Lee Gardner, a senior principal and consultant with RYAN Associates, adds:

"In my opinion, the economy has driven the need for a Total Health Management focus for employers and their employees.

"We are not saying the occupational medicine model should be one with urgent care. We are saying that episodic care in a customer friendly environment that is available to employers and their employees helps reduce emergency department visits, decreases the overall cost of care and provides one-stop shopping.

"The American College of Occupational and Environmental Medicine has long defined the role of occupational medicine as improving the safety and work environment for employers and their employees. What more expeditious way but to improve the health of the workforce AND provide appropriate access to care for all health concerns? Having the occupational medicine provider there can then provide meaningful return to work for all workers for work-related and non-work-related illness and injury."

What do you think? Please comment here or send email to Kohara@noahp.com.

An Aha Moment for HR Professionals

The Healthcare Performance Management (HPM) Institute released a report today that explains something with which occupational health professionals are already well-acquainted: Wellness and other preventive interventions can help reduce employers’ benefits costs, outcome analysis is critical and human resource departments should be paying closer attention.

The report, The Last Mile: The Role of HPM in Rounding Out the Enterprise Human Resource Management Mission, calls on companies to incorporate workforce health into their overall strategy for protecting and developing human capital resources. According to the report, “health and wellness programs have not traditionally been an HR function,” and employers tend to rely on third parties to develop and deliver content.

"Historically, executives have viewed their human resource departments as cost sinks," said George Pantos, executive director of the HPM Institute. "But with the help of innovative health care performance management technology that allows employers to measure and manage their benefits programs, business leaders can instead look to their human resource teams for savings."

The report endorses senior management support for greater fusion of human resource and HPM functions. For example, employers are encouraged to use software-enabled processes to track, monitor and manage health risks in targeted populations.

The report includes examples of how HR teams are deploying HPM technology to improve employee health and productivity.

"Using HPM tools, we are able to alter behavior by introducing opportunities for employees to live healthier lifestyles, and also to use their insurance in more preventative ways," said Michael Bekiarian, general manager of Sapien, a human resource management systems provider. "Outside the HR department, executives are seeing how a measurable decrease in absenteeism, for instance, results in greater productivity."

The Healthcare Performance Management Institute is a research and education organization dedicated to promoting the use of business technology and management principles to deliver better and more cost-effective health care benefits. Free registration is required to access the report on the organization’s website.

In Memory of Sue Clark

Sue Clark, founder and president of Alpha Pro Solutions, Inc., St. Petersburg, FL, and a member of the NAOHP Vendor Program, died Friday of cancer.

Sue was an exceptional resource on drug and alcohol testing, and more importantly, a great human being.

We miss her.

Her company announced it will continue to carry out Sue’s vision of training excellence. To view her obituary, visit http://www.memorialparkfuneralhome.com.

Providers Need to Do More to Educate Insurers

Insurers are unlikely to reimburse providers for taking a multi-disciplinary approach to the treatment and management of chronic pain because they don’t understand it, Jeffrey Livovich, M.D., medical director of the medical policy unit at Aetna said today at a Musculoskeletal Disorders and Chronic Pain conference in Los Angeles.

“It is really not in their vocabulary,” he told providers in the audience.

For example, multi-disciplinary care for chronic low back pain in workers' compensation cases is not widely available in the U.S., although a growing body of evidence suggests such an approach is effective. In the majority of cases, treatment remains fragmented and patients tend to shuttle from one provider to the next in search of solutions.

Multi- and inter-disciplinary pain management programs involve collaboration among medical and behavioral health professionals using a bio-psychosocial treatment model. The goal is return to function and maximum medical improvement. Studies show a team approach that involves physicians, physical and occupational therapists, vocational experts and psychologists helps reduce treatment costs while improving quality of life for patients.  

However, insurers perceive multi-disciplinary care as expensive care. While the average cost is about $30,000 per case when using that approach, Dr. Livovich said “that amount is in fact low" compared to the cost of interventions introduced over an extended period of time without achieving marked functional improvement.

The insurer’s job is to control costs: “Somebody has got to do it,” he said. But insurers also want to encourage the use of evidence-based care.

“We want to provide education and promote health and wellness. Insurers are much more interested in the well being of patients than you would imagine,” Dr. Livovich said.

At Aetna, clinical experts decide what will be covered based on the evidence - or lack thereof. This includes policies related to surgical interventions, acupuncture, electric stimulation and injections. Clinical claims review is primarily based on ICD-9 and CPT codes and reimbursement is largely automated, he said.

Because of the challenges associated with establishing charges for multi-disciplinary care in current payment systems, Dr. Livovich  suggests providers first identify their costs and then attempt to negotiate a case rate with insurers: “Start with contract negotiators in your region: ‘This is the program we would like to provide, these are our credentials, these are our outcomes.’ Then work out what you will get paid for it.”     

For the bio-psychosocial model to gain recognition and members of the provider community to be appropriately reimbursed for their expertise, Dr. Livovich said insurers need:

• More detailed information about the efficiency and value of a multi-disciplinary approach.

• To understand characteristics of patients most likely to benefit from this approach.

• To see outcomes related to return to work, increased function and other meaningful measures.

• To identify where and in what settings this type of care is available.

• Agree on parameters for accreditation and credentialing of provider teams.

The conference, “Musculoskeletal Disorders and Chronic Pain: Evidence-based approaches for clinical care, disability prevention and claims management,” sponsored by the Canadian Institute for the Relief of Pain and Disability and the American College of Occupational and Environmental Medicine, concludes Saturday. A key focus of the conference is the identification of high-quality research evidence that, if implemented into policy and practice, would improve clinical outcomes and prevent disability for adults with musculoskeletal disorders and chronic pain, according to the sponsors.