Occupational medicine physicians who are willing to step into the spotlight have a window of opportunity to play an influential role in the way workers and their families will access healthcare services in the U.S. for years to come. Those who linger in the shadows are likely to regret missing this chance to demonstrate the value of their under-appreciated specialty.
A growing number of health systems are finding that occupational medicine practitioners bring considerable expertise to high-level discussions on the development of emerging delivery models such as accountable care organizations (ACOs) and primary care medical homes (PCMHs). It makes sense: occ med docs are trained in population health management and certification in the specialty is awarded by the American Board of Preventive Medicine.
A process to link providers across the care continuum is consistent with an American College of Occupational and Environmental Medicine (ACOEM) policy that promotes the workplace as a pivotal venue for the provision of healthcare services. “ACOEM has multiple initiatives under way to try to articulate the role of occupational medicine in ACO and medical home models with the goal of integrating workplace, home and community into a true culture of health,” Pat O’Connor, the college’s lobbyist, told physicians during a recent policy briefing. The college is preparing to publish a white paper in February expounding on this issue.
In a follow-up interview, O’Connor told me the opportunity to have a voice in ongoing health reform dialogue is the most promising trend he sees on the immediate horizon for ACOEM members: “The workplace is organically connected to the home,” and vice versa. “We need to make sure occupational medicine is at the table as provider organizations, employers, government entities and insurers develop these models.” He is urging occupational medicine doctors to take the lead in return-to-work planning, disability management and related areas.
Employers are looking for advice on the infrastructure and policies they need to support access to comprehensive healthcare services for employees and their families, and in some cases, retirees. There are a number of factors driving their interest, specifically economics and provisions in the Patient Protection and Affordable Care Act.
As currently conceived, ACOs are intended to promote the delivery of quality care at a lower cost by holding providers accountable for their performance and rewarding them accordingly. ACOs are often couched as a promising next-generation model in which teams of clinicians, hospitals, insurers and suppliers collaborate to improve care for particular groups of patients. (For an ACO primer, I recommend Frequently Asked Questions about ACOs, a paper prepared by Aon Hewitt, a global human resource consulting firm, and Polakoff/Boland, a consulting firm specializing in healthcare value-based risk contracting. Managing Partner Phil Polakoff, M.D., M.P.H., is a board-certified occupational medicine physician with a unique perspective.)
The Affordable Care Act includes incentives for workplace wellness programs. For employers to qualify for grants, they must pursue certain goals: reduce risk of chronic disease, promote sustainable and replicable workplace programs, and conduct peer-to-peer healthy workplace mentoring – all areas of expertise for occupational health professionals. In a related activity, O’Connor said ACOEM is helping the Centers for Disease Control and Prevention (CDC) develop methodology to make the business case for worksite wellness programs. ACOEM also sponsors a Health and Productivity Management (HPM) Center and toolkit that features a broad range of related materials.
As for the primary care medical home, the Agency for Healthcare Research and Quality describes it as a program “accountable for meeting the large majority of each patient’s physical and mental health care needs, including prevention and wellness, acute care and chronic care.” These needs certainly are familiar to occupational health professionals based at worksites, hospitals and clinics. They have long been accustomed to delivering cost-conscious, evidence-based medical care.
Regardless of what happens in Washington with health reform, we can expect changes at the state and local level. In Ohio, for example, where seven of 10 leading causes of death are linked to lifestyle choices and preventable conditions, Gov. Kasich has created an Office of Health Transformation. The office supports the Ohio Patient-Centered Primary Care Collaborative, a coalition of primary care providers, insurers, employers, consumer advocates, government officials and public health experts. The state also has allocated $1 million to train clinicians and office staff in 50 different practices statewide to more efficiently manage electronic medical records, disease registries, and patient scheduling and referrals. “It really is getting us up to the 21st century in the way we practice medicine,” said Dr. Ted Wymyslo, state health department director.
Employer involvement in a value-based, team approach to health care delivery supported by instantaneous transmission of electronic health records (with privacy safeguards, of course) and specialized software solutions seems even more logical when one considers findings from a study published recently in the Milbank Quarterly (Vol. 89, Issue 4, Dec. 22, 2011). According to the study, Economic Burden of Occupational Injury and Illness in the United States, medical and indirect costs of occupational injuries and illnesses totaled $250 billion in the study year (2007), far exceeding costs associated with cancer ($32 billion) and diabetes ($76 billion).
Workers’ compensation covers less than 25 percent of work-related injury and illness costs, so all members of society share the burden, says the study’s author, J. Paul Leigh, a public health sciences professor at the University of California, Davis. Leigh also notes that allocation of scarce health care resources requires knowledge of disease costs, which ties directly to employers’ need to better understand and manage workforce health.
And that’s where we circle back to occupational medicine physicians…
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