Benchmarking fine-tunes health efforts for workers

Post-merger project reaffirms areas of excellence

Hospital health care professionals are no strangers to corporate mergers, which can present some unique challenges when it comes to benchmarking.

The merger of two non-health care firms is no less of a challenge to those responsible for the health and well-being of their employees; and benchmarking can help outline both the strengths and the weaknesses of the organization as its health care professionals seek to improve health care services they deliver to their workers.

It was just such a merger that, in part, provided the impetus for benchmarking studies at Marathon Oil Company (MOC) in Houston, and Marathon Ashland Petroleum LLC (MAP), based in Findlay, OH. MOC is an integrated energy business and a top-five U.S. oil company specializing in exploration and development activities in 10 countries.

MAP was formed Jan. 1, 1998, from a joint venture arrangement incorporating the downstream operations of its long-established parent companies, Marathon Oil Corp. and Ashland Inc.

"We conducted the benchmarking project in 2000, based on 1999 data," explains Brian J. Linder, MD, MPH, medical director for both companies. "The survey instrument was a semiquantitative tool designed to measure the effectiveness of corporate health programs. We looked at business functions and the outcomes data we had been collecting across the entire occupational health department."

Marathon sought the assistance of Medstat, an Ann Arbor, MI-based health care information company that provides market intelligence and benchmark databases, decision-support solutions, and research services for managing the cost and quality of health care.

"Putting together the joint venture forced us to critically review what we were doing within the department so best practices could be identified and implemented," Linder recalls. "This process became complicated when we discovered there were no uniform data sets to compare between the companies. Moreover, it was difficult to even agree on what data sets and business functions were more important. This obviously led to a lack of consensus on critical outcome measures."

Shortly after the merger, Linder says, "There was a strong desire to be certain that what we were doing [in health services] and what we had just put together were not out of the mainstream and could be demonstrated to be a best practice. Benchmarking is the cornerstone to continuous improvement; you should always be asking yourself how you stack up."

Also, Linder wanted to more closely align his department’s goals with the broader goals of the company and develop tools and metrics to measure performance, not only companywide but also at the business unit level.

"That’s what led us to call Medstat to see if they could help us come up with something that would lead to performance improvement and enhance the information we were gathering and analyzing," Linder says. "On the health and wellness side, we wanted to come up with some aggregate measure that would identify corporate health."

"We were in a great position to help as a third-party entity," says Arlene Guindon, MPH, director of client services at Medstat and Linder’s partner in the project.

"They needed a static group of measures to compare to the larger group [of employers]. It really helped us that Dr. Linder was the medical director for both organizations. Having a person with passion and vision, plus recognizing the need for common measures, really helped us move forward," she explains.

While the project was not undertaken for a health care company, Guindon is very clear that this was a health care benchmarking study.

"We collected key metrics on employee health, environmental health, organizational health, and organizational leadership," she notes. "A key parallel with health care organizations is that the data was used by Marathon to identify any information gaps for collecting those measures or enhancing them for employee health; this applies to any industry or occupier."

This also was a health care effort in the sense of looking at top disease and injury conditions — regardless of how the worker entered the system, whether he or she was injured on site or off, Guindon notes.

The tools used were also quite similar to those used in the hospital setting. "Hospitals participate in health and productivity surveys for us that are very similar," she says. "The main difference is they look at benefits as well, so theirs are a little broader."

Setting the parameters

"When we sat down with Medstat, we had three objectives we wanted to accomplish from the project," Linder says. "First, we wanted to profile the makeup of participating medical departments to identify leading management practices and measurement tools. In addition, we wanted to identify the relevant outcome measures that were reflective of employee organizational and environmental health. And finally, we wanted to use the data from the survey instrument as a catalyst to promote continuous improvement within the department."

This was not the first time Linder had worked with Medstat. Medstat had done a very large benchmarking survey in health and productivity in 1998; and in 1999, Marathon decided to use its 1999 data against its survey respondents’ data for 1998, basically focusing on disability.

"We became really acquainted with them and their abilities during that exercise," he notes. "Following that project, we decided to broaden things and take it across our entire department."

The following were key areas of assessment in the medical department benchmarking study:

  • employee examinations;
  • workplace injuries and illnesses;
  • occupational and nonoccupational disabilities;
  • nonoccupational disabilities;
  • employee assistance program performance;
  • substance abuse programs;
  • travel medicine services;
  • industrial hygiene programs;
  • hazard communication programs;
  • health promotion and wellness population assessments and research.

There were 21 participants in the benchmarking survey. "In helping us put together the survey, Medstat sent out letters to other Fortune 500 companies in their book of business, asking them to participate," says Linder. "We were blinded to the respondents. Interestingly, about a third were other oils’ — and most of the majors participated."

What did the survey show? "In a nutshell, there were some areas where we clearly were a best practices company — for example, disability management and occupational hygiene," says Linder. "In addition, the core occupational health disciplines here were above average, so we developed a sense of comfort that we were either in the ballpark or even ahead of the curve."

One area the study indicated could use some attention, however, was the employee wellness and health promotion program. "From this study, we decided to focus on that program — on participation rates, on what was being offered, and on how much was being offered," says Linder.

Together with the benefits department, the company "completely reworked" the health promotion program, he says. "We reviewed what other people were doing in 2001, and we re-examined the purpose of health promotion and disease prevention today compared to what the intent of the program was when we put it in place in 1989," he says. "And our people then built what I think is a world-class program."

The American College of Occupational and Environmental Medicine (ACOEM) in Arlington Heights, IL, agrees. The organization bestowed its coveted Corporate Health Achievement Award on Marathon this year. Among the most impressive of its achievements was the creation of the "Well ALL Ways" program, which has boosted participation rates in health risk appraisals (HRAs) from 15% to 75%-80% in two years. HRAs are critical to employee health efforts because they establish baseline data that wellness professionals can use later to evaluate program effectiveness, and because they can identify at-risk employees.

Having had the assistance of Medstat made a big difference in the process, says Linder. "These studies require a lot of effort," he notes. "To do them correctly requires partnering with someone who can supply the necessary horsepower and expertise."

Objectivity also was critical, he adds. "If we had done this on our own, the results may have reflected my biases regarding how a corporate medical department should be run. I really wanted to learn from the study," Linder adds.

"We helped them walk through the process and understand the responses they sent back, without showing affinity for any organization," Guindon says.

Health care providers can draw valuable lessons from studies like these, she continues. "Even those companies that are focusing on occupational health are starting to focus on more nonoccupation-related issues, like preventive screenings. If you try to adapt preventive health care guidelines into any system, it helps you manage overall health care costs."

The productivity issues contained in these studies also should send a message, Guindon says. "Productivity improvement can really contribute to a hospital’s QI efforts."

Need More Information?

For more information, contact:

• Brian J. Linder, MD, MPH, Medical Director, Marathon Oil Co./Marathon Ashland Petroleum LLC, 539 S. Main St., Findlay, OH 45840-3295. Telephone: (419) 421-2062. Fax: (419) 421-4559. E-mail:

• Medstat, 777 E. Eisenhower Parkway, Ann Arbor, MI 48108. Telephone: (734) 913-3000. Web site: