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Occupational medicine on the fast track

By Josh Shepherd

Kentucky healthcare providers have met business market demand for workforce productivity and lower healthcare costs by evolving the industrial health offerings of yesteryear into integrated occupational medicine programs that customize services while generating savings that can run into seven figures.

Occ health  MAIN_155093987Healthcare plays an increasingly crucial role in the economic wellbeing of a community as an important partner to business and industry. Without its presence, a community’s business development efforts are limited. Today’s occupational medicine programs are becoming an indispensable tool for businesses to enhance revenues and cut costs.

The emerging national conversation about preventive medicine and wellness services might give the impression that these are new concepts and a bold step forward. Actually, hundreds of private companies, from manufacturing firms to the service industry, have long recognized that attending to the health needs of their employees makes a huge impact on a company’s bottom line.

Occupational health services have been around the healthcare landscape for decades. Their development as a standard service line in most hospitals, physician’s offices and urgent care centers is a classic example of how service industries can be responsive to the needs of their local companies.

The origin of today’s integrated, proactive services began modestly in response to regulations handed down from the Occupational Health and Safety Administration (OSHA) and drug screening requirements from the Department of Transportation (DOT). Add the participation of workers’ compensation insurance programs and it wasn’t long before companies began knocking on the doors of local hospitals requesting help with complying with these regulations.

In the past decade especially, the major healthcare systems in Kentucky have worked to develop and expand the scope of their occupational health service lines. They share many of the same basic services, including pre-employment physicals, DOT and non-DOT drug screens, physical therapy and long-term work-related rehabilitation, and urgent care and emergency injury treatment.

Although a wide range of private specialists, dedicated clinics and urgent treatment centers offer occupational health services, Kentucky’s major health systems are using their name recognition and growing presence throughout the state to brand their service and expand their scope to companies of all sizes statewide.

Four of the largest system-based occupational medicine programs in Kentucky are KentuckyOne Health, Baptist Health Occupational Medicine, Saint Elizabeth Healthcare’s Business Health Services, and LifePoint of Central Kentucky’s WellnessWorks.

They have been providing occupational medicine at some level for at least a decade, beginning as modestly disorganized groups of services under several managers and departments. Program directors, however, have nurtured them today into distinctive and integrated lines of service with dedicated staffs of board-certified occupational medicine physicians and physician extenders, specialized occupational health nurses, physical therapists and rehabilitation specialists.

“In the beginning, businesses approached us to create a transactional service for the health and safety of their workers,” said Shirley Kron, regional director of KentuckyOne Health’s occupational medicine service. “They needed us to comply with federal mandates through OSHA and the DOT. They also wanted someone to treat work-related injuries.”

Deborah Hall, Baptist Health occupational medicine director, described the early relationship that occupational health had with private industry as reactive rather than pro-active.

“Better than 20 years ago, the management styles of most industries were, to be blunt, not to manage,” Hall said. “We were contracted to tend to injuries as they occurred and keep everybody in regulatory compliance.”

It was around that time, though, that businesses recognized how much healthcare costs were eroding their bottom line – and how local healthcare providers could offer them lower cost solutions.

“For many companies, their entry point into a business health service is usually the basics,” said Tina Legris, director of Saint Elizabeth Healthcare’s Business Health Services program. “Business health services all provide programs to get companies compliant with federal regulations. But once they realize how much they can reduce costs by taking advantage of our wellness and preventive health services, the relationships we have with our clients go much further.”

Indeed, occupational health services that have the greatest measurable impact on reducing healthcare costs are in health and wellness programs. It hasn’t taken long for human resource managers to appreciate the range of applications and the cost savings that an effective prevention and wellness program can have.

Occ health_136002713“Maintaining a healthy workforce can have a tremendous impact on a company’s bottom line,” Kron said. “Regardless of whether the employee is on a production line or providing the company professional services from an office, injuries and chronic illnesses that are left untreated are going to have a negative impact.”

Savings can become significant. Hall cited a specific instance.

“One has to factor in the cost of replacing that person, the loss in productivity by having them absent, even what the cost will be to put a new person into that position and the downtime it will take to get them up to speed,” Hall said. “One of our clients was a manufacturing firm that had a one-year workers’ compensation cost of about $1.6 million. The full-time occupational health nurse we brought on site, backed, of course, by Baptist Health Occupational Medicine, was able to reduce those costs. Three years after we set up an occupational health nurse and staff to provide well-care services, their workers’ compensation cost went down to $400,000.”

That savings, she said, is one concrete example of how covering the expense of wellness services at the front end can reduce overall healthcare costs. Such savings are particularly coveted by companies that self-insure their employees, Hall said.

Programs crafted for specific needs

These services can take many forms. In fact, a hallmark of all occupational medicine programs is the flexibility of their services. For a program to be competitive, it must be able to cater to the unique needs of clients from manufacturers with workers on an assembly line to the executive leadership of professional service organizations.

“We provide a full menu of wellness counseling and consulting services to a client free of charge,” said Sarah Alexander, coordinator of LifePoint’s Wellness Works program at Clark Regional Hospital in Winchester. “We custom tailor our services to meet the specific needs of their customers. And best of all, the majority of these services can be brought on-site.”

Occupational medicine is one of the few services health systems provide that extend beyond the physical walls of a clinic or facility. For manufacturing firms, occupational health professionals often provide job-site analyses that can identify areas where employees are put at unnecessary risk or even evaluate processes that could result in long-term repetitive-motion injuries.

It is misleading, however, to describe in-house services as “new.” Occupational medicine has always been about attending to the needs of companies in the most convenient manner possible. Bringing services directly to a company worksite was a natural evolution of delivering business health services, Hall said.

A service common to all the health systems is an employee assistance program (EAP). EAP is a catch-all term that describes a wide range of in-house services. They can be as direct as providing on-site wellness counseling seminars, employee immunizations and helping specific workers manage chronic diseases such as shortness of breath, repetitive motion injuries or diabetes. But under this service umbrella, larger healthcare systems can draw on their professional medical staff to address personal and even behavioral health issues, including mental health condition treatment.

“It really is a matter of what a company would like us to provide. We will find a way to help them,” Alexander said.

Being able to provide the right kind of short-term physical therapy or rehabilitative care for injuries that require a longer repair time is a key service in occupational health.

“Losing an experienced line worker can cost a company $1,000 a day in lost productivity,” Kron said. The goal for this service is to reduce as much as possible a worker’s downtime due to a physical injury. “We want to return that worker to the floor able to perform their job to the same capability as before or, better yet, with improved capability.”

In general, occupational medicine is reimbursed through workers’ compensation insurance benefits or a company’s predetermined fee schedule for services. There is very little traditional health insurance billing for services.

Given the growing emphasis on health and wellness, however, occupational medicine services are considering expansions into the realm of primary care. There is room, Hall argues, for larger companies to contract with occupational medicine programs to provide employees with primary healthcare.

St. Elizabeth Business Health Services has put this idea into practice at a company administrative level. A distinguishing feature, and one that allows St. Elizabeth’s to separate itself from competitors, is its unique executive health program, which is designed to offer a comprehensive physical exam that includes state-of-the-art diagnostic screenings and lifestyle consultations.

“Companies these days are investing a lot in their senior leadership,” Legris said. “It is in their interest that these executives maintain good health. We are very proud of the success that we have had with our executive health program.”

Offering primary care services to private companies has been tried before with varying degrees of success. For larger clients, every healthcare system has contracted to staff a company office with an occupational health nurse overseen by an occupational health specialist.

Professionals of this caliber in Kentucky can be hard to come by, especially physicians. While there are several programs at the college level that offer training in occupational health services, only the University of Kentucky’s College of Public Health offers a fellowship program in the occupational medicine specialty.

Saint Elizabeth Healthcare, Baptist Health Occupational Medicine and KentuckyOne Health are not employing many salespeople to market their services to companies. More often than not, each director said, clients are actively soliciting them for their services.

With regard to primary care, though, all of them have said they are still several years away from a potential next step of approaching partnerships with health insurers.

Occupational medicine programs

Of the four programs that contributed information to this article, St. Elizabeth Business Health Service has the tightest geographic service region. Its primary area is the business community of Northern Kentucky and the Greater Cincinnati tri-state area.

Potential clients can find out more about their service by visiting
stelizabeth.com/businesshealth/.

♦ KentuckyOne Health, the largest heathcare system in the state with over 200 hospitals, medical service centers and clinics, is in the process of merging two well-regarded occupational health programs: Jewish Health’s Employcare and the Saint Joseph Health Systems Medworks. The scope of its service touches Lexington, Louisville and significant portions of central and eastern Kentucky as well as southern Indiana. It is further backed by its partnership with the University of Louisville. The major advantage they offer is the backing of their respective health systems. A company that contracts with KentuckyOne Health’s service in Louisville has access to support services at every KentuckyOne health location throughout the commonwealth.

Potential clients can find out more about their service by visiting kentuckyonehealth.org/occupational-health.

♦ The Baptist Health Occupational Medicine, formerly BaptistWorx, is re-branding itself under the umbrella of the statewide Baptist Health system. Baptist Health Occupational Medicine service line reaches across the commonwealth with support services at all its major healthcare centers in Corbin, Richmond, Lexington, Louisville, Madisonville and Hopkinsville. Participation in Baptist Health, likewise, extends its partner services to every facility under their umbrella.

Potential clients can find out more about their service by visiting their website: baptistworx.com.

♦ Wellness Works, the Occupational Medicine Service Line with LifePoint Hospitals of Central Kentucky, is a relative newcomer to this highly competitive arena, but its experience working with companies in developing small cities allows it to extend coverage into several untapped markets across the Bluegrass. In addition to its holdings around Lexington, Winchester, Georgetown, Versailles and Paris, Lifepoint has a considerable presence in many of the smaller, but developing cities throughout Kentucky such as Lebanon, Maysville, and in Kentucky’s Purchase area.

Potential clients can find out more about their service by visiting their website: clarkregional.org/services/wellnessworks.aspx.

Josh Shepherd is a correspondent for The Lane Report. He can be reached at [email protected]