What must be part of any business strategy?

Today's employers are looking very closely at both direct healthcare expenditures and indirect costs associated with absenteeism, presenteeism, and disability.

"We have now reached a state where businesses simply cannot compete without addressing the role that health of the workforce has on their bottom line," says Steve Schwartz, PhD, research director of HealthMedia in Ann Arbor, MI. "Occupational health must take a leadership role if we are to be successful."

The solution has to be more comprehensive than just providing health insurance, an Employee Assistance Program, or healthier choices in company vending machines. Instead, says Schwartz, the solution must be strategic, comprehensive, evidence-based, and economically sustainable. "It must be driven by the organizational leadership, and tailored to both the individual's needs and the organizational needs," he adds.

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Schwartz says that occupational health programs and clinicians are particularly well-positioned to drive the type of cultural change needed within organizations for total population health management.

"In many respects, they have the most to gain in terms of reduced healthcare costs, improved morale, reduced turnover, and greater productivity," says Schwartz. He gives these recommendations:

• Include services for workers who are essentially healthy.

You are not only addressing those with advanced risks or acute conditions, but also healthy workers. "Foster health and well-being across the health spectrum," says Schwartz. "Keep workers healthy, happy and highly functional."

• Develop a clear, evidence-based economic argument.

First, address the negative impact of doing nothing. Then build an argument for the positive impact of health and wellness programming. In addition to population risk profiles, also consider the "right-sizing" of direct healthcare costs. "Health promotion can, in the short run, increase certain cost categories," notes Schwartz.

• Avoid choosing a measure that is not well-suited to the overall measurement intention of the organization.

"While some have been very vocal about identifying a particular measure as the gold standard, our position is that the field needs a variety of psychometrically sound measurement tools that address certain questions and situations," says Schwartz.