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ACOEM: Wellness at work belongs in HC reform
Occ-med docs push for 'integrated' focus
All the shouting (Death panels! Rationing!) has gotten the press attention in health care reform. But in the behind-the-scenes effort to create a new paradigm, occupational health physicians have promoted prevention, workplace- based wellness, and the link between workplace health and productivity.
Occupational health physicians from the American College of Occupational and Environmental Medicine (ACOEM) met with members of Congress and presented their action plan:
They would like a requirement for employer-provided health plans to include an "integrated health and productivity enhancement program for work-site prevention, health promotion, and health protection" which would be overseen by an occupational medicine physician. They want employer-based health plans to be required to reimburse for preventive services provided to employees. And they want tax credits for employers that offer "comprehensive and effective wellness programs."
"We have really made it our mission this year to talk about work-centered health care reform," says ACOEM president Pamela A. Hymel, MD, MPH, FACOEM, corporate medical director of Cisco Systems in San Jose, CA. "We do believe the workplace is the cornerstone for improving health in so many areas."
ACOEM supported the Healthy Workforce Act, which would provide tax credits for employer-based wellness programs. While many large employers have developed employee wellness and health promotion programs, many others still have not made the investment in their workers' health, says Hymel.
"We are going to remain active every step of the way [in the health care reform debate]," she says. "We not only want to improve the health of the person in the workplace, but improve the health of the work force."
Invest in health of 'human capital'
The bottom line: Money spent on wellness is an investment in your human capital, says Ronald Kessler, PhD, professor of health care policy and a participant in ACOEM's National Workforce Health and Productivity Summit in November 2008. "It's very difficult to think of anything that will improve the efficiency of workers more than improving their health," he says.
There's the obvious savings in reducing the number of workers who are out sick and need to be replaced by temporary workers. But workers are also much more alert and productive when they're healthy. And they are less likely to suffer from a workplace injury, says Kessler, who developed the Health and Work Performance Questionnaire.
That is why employers are willing to pay incentives to employees to participate in health risk appraisals, smoking cessation, and other health promotion programs. A 2008 survey by the Integrated Benefits Institute in San Francisco found that about three-quarters of employers offer incentives for employees to participate in health and productivity initiatives. For one in five employers, those incentives were valued at $400 or more per employee.
Occupational health is more than injury response or even injury prevention; it should encompass efforts to improve the overall health of the work force, the ACOEM summit concluded. "Continuing the status quo of current health care strategies in the workplace is not a sustainable option; the realities of the economic burden of health risks and health conditions, rising total costs and an increasingly competitive global marketplace require an urgent shift to integrated health and productivity improvement strategies," the summit participants concluded.
Hospital reshapes workplace health
Employers can shape employees' health patterns, most obviously by deciding whether or not the health benefits will include preventive care, notes Robert McLellan, medical director of the Live Well, Work Well program at Dartmouth Hitchcock Medical Center in Lebanon, NH, and associate professor of medicine and community and family medicine at the Dartmouth Medical School in Hanover.
They also shape the workplace by determining shifts and schedules, easy access to stairwells and walking paths, and even what is served in the cafeteria, notes McLellan, who is past president of ACOEM and a participant in the summit.
But other factors influence employee engagement with health promotion and their participation in health risk appraisals, he says. In a recent study, McLellan and his colleagues found that participation in voluntary health risk appraisals varied widely by job type (from 17% to 56%). Job satisfaction also influenced employees' level of participation.1
"[Employers'] fundamental responsibility is to provide a safe and healthy work environment. That's law," he says. "It is well recognized that when employers do not live up to that obligation, their employees are not going to be receptive to employer-sponsored health promotions."
An employee's perception of supervisors also affects their health decisions, McLellan says. "The way midlevel management treats their employees has an impact on their personal health behaviors," he says.
Dartmouth Hitchcock designed the Live Well, Work Well program to leverage the workplace attributes to improve employees' health. It encompasses everything from healthier choices in the cafeteria to policies and changes in the physical environment that will reduce hazards and promote healthier activity. The medical center encourages employees to take confidential, online health risk appraisals and provides health coaches. Care managers assist employees with chronic conditions such as diabetes.
The goal: To create a culture of health, safety and well-being, says McLellan. "We have the ability to reform health care right here at Dartmouth Hitchcock Medical Center," he says. "We want to deploy a suite of programs and services and interventions to optimize people's well-being and reduce their health risks, disease and associated costs."
Dartmouth Hitchcock may then be able to prove a point - that the nation's workplaces can be at the center of improving the nation's health.
(Editor's note: More information about ACOEM's Healthy Workforce Now initiative is available at www.acoem.org/healthyworkforcenow.aspx.)
1. Feng YY, McLellan RK, MacKenzie TA, et al. Impact of workplace sociocultural attributes on participation in health assessments. J Occup Environ Med 2009; 51:797-803.