The Obama administration’s plans to move forward with a technology driven “medical home” initiative as part of overall efforts to reform the nation’s health care system is generating speculation about potential long-term impacts on the practice of occupational medicine.
The administration’s support of prevention initiatives as well as studies aimed at improving quality and lowering costs also are expected to have a halo effect. The federal budget introduced by the Obama administration sets aside a reserve fund of more than $630 billion over 10 years that will be dedicated to financing health care reforms, and the president says he is committed to working with Congress to find additional resources.
1 “Reforms will affect all medical specialties and practices,” Clarion Johnson, M.D., global medical director for Exxon Mobil Corporation, said during a session on health care reform at the American College of Occupational and Environmental Medicine’s annual conference in April. “Occupational medicine physicians will encounter challenges that reflect on the many settings in which we practice.
How proposed reforms look depends on where you are standing, but even a few, if enacted, will make things better than they are now.” There is a difference in opinion between experts and average consumers about problems with the U.S. health care system, according to polls conducted by the Kaiser Family Foundation.
Experts target unnecessary and troubling variations in care. Consumers appear to be more concerned about under-service than over-service, and they are worried about how they are going to pay for the care they receive. In an April survey, a majority of respondents said they or a member of their household have delayed or skipped health care in the recent past.
2 “These differences between experts and the public matter because key elements of health reform which elected officials expect to resonate with the public could get a decidedly less enthusiastic reception than expected if more is not done to close the gap in basic premises and beliefs between experts and the public.”
Drew Altman, Ph.D., Kaiser Family Foundation president and CEO says in a recently published commentary. “Most fundamentally, the challenge is to educate the public about why health costs are rising as fast as they are in the U.S.” According to the Robert Wood Johnson Foundation, a research institution whose mission is to improve the health of all Americans, the key driver of spending—accounting for an estimated one-half to two-thirds of spending growth—is technology, not changing demographics or medical malpractice. Other important drivers of health care spending include health status, particularly obesity, and low productivity gains in the health care sector. In addition, higher spending does not achieve better outcomes, the foundation reports.
While there are many proposals on the table, Dr. Johnson said he expects expanded coverage for the uninsured and federally supported insurance plans to top the federal agenda, along with expanded use of communications technology, a greater focus on wellness and improved incentives or payment for better care. He noted that Exxon Mobil is a self-insured company, and when it comes to the health and well-being of its employees, there is no room for compromise. Consequently, the company’s ongoing focus is on cost savings and quality. For example, it is working with multiple vendors on information technology solutions, improved care management capabilities through the use of evidence-based medicine and the development of safer work environments for its employees.
Integrated Coverage is among the many proposals under consideration, various permutations of the integrated, or 24-hour care, delivery model are likely to be resurrected as part of reform discussions in the coming months, predicts Doug Benner, M.D., an occupational medicine physician who coordinates the occupational health program for Kaiser Permanente, Oakland, Calif.
However, while workers’ compensation is on the radar, it is not yet clear how prominent a role it might play given the overall magnitude of the nation’s heath care crisis, he said. There are a growing number of integrated disability management programs, but many barriers to a fully integrated health care delivery system remain.
State-specific regulations and the entitlement mentality inherent to workers’ compensation are two reasons why it is challenging to integrate occupationally focused care with non-work-related medical treatment and disability management programs.
However, despite these obstacles, Dr. Benner says considerable efficiencies and better outcomes can be gained when patients are treated by the same physician or medical group under the same health plan, regardless of the cause of their injury or illness.
“A lot of physicians don’t want to do workers’ compensation,” in part because it is so paperwork-intensive, he said during a presentation in May at a Workers’ Compensation Forum sponsored by the Council on Education in Management. “We need physicians who understand workers’ compensation, return to work, disability and function.” Aetna, one of the nation’s leading diversified health care benefits companies, recently reported results from a set of analyses of members with access to integrated benefits compared to control groups without integrated benefits.
The most significant finding from the studies showed members with integrated benefits were more likely to take a health risk assessment and enroll in wellness and disease management programs that contribute to healthier behavior and improved health risk.
“When we have a more complete picture of our members and all the benefits available to them, we can have a much greater impact on their health outcomes and on their overall willingness to engage in their health care,” said Laurie Brubaker, head of Health and Productivity Solutions for Aetna.
Aetna offers an Integrated Health Solutions (IHS) product that includes a risk assessment with questions on work limitations and productivity based on health and emotional conditions. Risk indicators trigger one-on-one wellness counseling to address conditions holistically through other Aetna programs, often before they involve costly acutecare services, company officials said.
“The results suggest that increased coordination of services and member engagement in managing their health condition may be the keys to decreased short-term disability (STD) durations and fewer complications,” Ms. Brubaker said. “Earlier Aetna studies demonstrate that STD claim durations were 3.2 days shorter with integrated health and disability benefits.”
Excerpted from article by Karen O’Hara in VISIONS –
The Periodical of the National Association of Occupational Health Professionals