Healthy employees mean a healthy company.
To achieve this goal, employers are looking for greater integration among their many workplace benefits programs, including workers' compensation, disability management, wellness and prevention--and even group health benefits. The guiding principles are that these programs will benefit all involved: the employee who is able to return to work more quickly and stay at work after an illness or injury, and the company that is looking to prevent, as well as manage, illness, injury and disability.
Companies are embracing health and wellness practices within the design and delivery of their benefits, although these programs are far from universally adopted. Advocates realize that carefully planned and implemented health and wellness programs, which are part of a corporate culture and built around sound practice, can help mitigate or even avoid health risks in the future.
"As health-care costs rise, the result is a serious hit to the bottom line of the organization.
A direct way for an employer to respond is to drive employee behavior to make them more accountable for their health-care spending by looking for ways to engage employees. Whether requiring them to share the costs of their health care or promoting their willingness and ability to maintain or improve their health, both the employer and the employee will have significant gains as they get older and continue to work," says Edwin Quick, a commissioner with the Certification of Disability Management Specialists Commission.
Employers, of course, still face challenges to address health-care inflation, to promote employee wellness, and to reduce the incidence of both occupational and nonoccupational illness, injury and disability. In the past, companies tended to tackle these issues within specific benefits silos: workers' compensation, disability management and group health. For example, to control group health and pharmacy costs, companies would shift a larger portion of the costs to employees or offered tiered benefits with different cost and coverage structures.
Now employers are realizing that, by offering health, wellness and disability management programs that emphasize prevention, they are likely to avoid costs in the future. This is particularly significant given the aging of the work force.
"Fostering our associates' health and well-being is our goal and certainly one of our top priorities. As a health-care provider, we have to make sure we take care not only of the health of our external community, but also our 'internal' community," says Suzann Bylund, a registered nurse and director of workers' compensation and disability management at Ascension Health. The St. Louis-based Ascension Health operates 64 acute-care hospitals, six long-term-care hospitals, four rehabilitation hospitals, four psychiatric hospitals and nine nursing homes.
"One way to promote health and wellness among Ascension Health's 107,000 associates is to continually review health plans, including the 'touch points' where employees can be channeled from one benefits program into a wellness program or other health initiative," Bylund explains.
Evidence of increased employer involvement in benefits design, implementation and delivery was found in recent field research conducted on behalf of the CDMSC. In particular, the CDMSC, the only independent, nationally accredited organization to certify disability managers, found that employers are taking a more integrated approach to health care and disability management.
More emphasis is being placed on strategies and programs that address safety, prevention, return to work, sustained employability and productivity. This emphasis places greater demands on multidisciplinary teams that bring together human resources, benefits and compensation, risk management, disability management, vendors and third-party providers--both inside and outside the company. The objective is to develop programs that will demonstrate to management a positive return on investment in terms of improved corporatewide health and productivity.
Coordination of benefits programs requires consistent measurement tools, benchmarks in disability management and absence management practices, and standard outcome measures. One important example is the national standardized metrics initiative known as EMPAQ, or Employer Measures of Productivity, Absence and Quality. EMPAQ was designed and launched in 2004 by the National Business Group on Health's Council on Employee Health and Productivity, bringing together employers, insurers, suppliers, universities and industry organizations. EMPAQ metrics are now embedded within a benchmarking program developed and provided by the Integrated Benefits Institute. (See "Disability Management Measure for Measure," Risk & Insurance®, June 1, 2006.)
In order to assess and benchmark their disability management and absence management programs, employers need to collect, review and analyze data--and then use the findings to improve and refine benefits programs.
"Participating in EMPAQ has really helped us to guide our programs with appropriate improvements, and therefore see better results," Bylund says.
Companies need to review their health, wellness and intervention programs in order to respond to the many demographic factors that impact both the current experience and the outlook for employee health and productivity. One is the aging employee population. A larger proportion of workers age 40 and older are likely to see increased medical problems from more than one serious or chronic condition (also known as comorbidities). And for a number of reasons--from economic need to the desire to remain active--older workers are staying on the job past the typical retirement time of age 55 to 65.
These older workers are valuable to employers for many reasons, including on-the-job and life experience. In addition, there are not enough younger workers in the ranks to take the place of the aging baby boomers when they retire. At the same time, many of the younger workers entering the job market are less healthy than the 20-year-olds of two or three decades ago. Lifestyle and dietary habits among younger workers have resulted in a higher incidence of health problems such as obesity and diabetes.
"Employers are finding themselves facing the challenges of baby boomers who have health issues related to aging, and also a younger population that is less healthy than previous generations," comments Quick, who is also global disability lead for GE Energy Services in Atlanta. "The good news is, if companies do their health, wellness and prevention programs well, they can impact these two key groups. In fact, with some program adjustments for age, employers can serve the entire population across a broad spectrum of programs."
Health promotion cuts across all segments of the work force--not only older and younger employees, but also the white-collar worker who experiences stress, blue-collar workers who may be aging out of physically demanding jobs, and a culturally diverse work force that places different demands on a health-care and wellness system. From a global perspective, the implications for health and wellness are critical in developing countries, as well as in overseas markets where this has not been an emphasis in the past. These issues point to the long-term health promotion challenges for employers.
TO THE RESCUE
One of the key players on the workplace productivity team, according to CDMSC research, is the disability manager, who is already involved in disability case management, prevention and workplace intervention. When a disability manager develops a return-to-work program after an illness or injury, for example, health, fitness and wellness activities can be incorporated into that plan and be supported long after the employee has returned to his or her job.
In a more organizational role, disability managers are becoming involved in areas such as benefits designs that integrate wellness and health promotion initiatives, policies and procedures that are built upon best practices, presentation of the business rationale for disability management programs that integrate prevention with safety and return-to-work, and championing individual and organization behavioral changes. They also utilize internal and external health-care services and resources that have a common value and expertise related to prevention outcomes, manage the internal and external service providers to measure desired outcomes, take the lead in the exchange of data and metrics among stakeholders in the various benefits plans and programs, and conduct program evaluations to measure both satisfaction and the bottom-line return on the investment.
These new and evolving responsibilities for disability managers show the depth of coordination among benefits programs and initiatives. Employers are in the proverbial driver's seat of this change, requiring closer coordination among vendors and third-party providers. As employers adopt a coordinated model, they are requiring that their vendors do the same.
Often these models utilize population health initiatives to identify common causes and health issues across benefits programs. The issue is not whether a case involving an employee with, for example, a back injury is handled by workers' compensation, group health or short-term disability. The issue is the health condition itself. Once a picture is developed of the types of health issues within his or her particular employee population, the employee can be stratified from catastrophic to low-risk, with different strategies and incentives for each.
For example, those employees who have high-risk diseases may be channeled into disease management programs through a group-health vendor. Regardless of how employees enter the system, they can be referred to the programs and initiatives that will positively impact their health. Participation in the programs such as disease management, and other health, wellness and prevention initiatives, is voluntary. However, employers are seeing willingness among employees to participate and the positive impact of peer influence. "Employers know that people who are physically active will participate in these programs. What they are seeing now, at least anecdotally, is that this is spreading into other populations," observes Quick. "People don't want to be unfit or unhealthy. Depending on how easy the programs are to access and how user-friendly they are, more employees will be encouraged to also participate."
Companies are also using incentives to involve employees. Rolling out programs and incentives for participation will also require a coordinated effort, not only among the benefits team members, but also involving other company departments such as corporate communications and marketing. The foundation of these initiatives must be a supportive corporate culture that sees the long-term benefits of improving the health of all employees, and with management behaviors that mirror these goals.
"Getting people to participate can be incentive-driven, depending upon plan design or program, but much has to do with communication and education," Bylund says. "The challenge then is to get our associates to participate and to know that they are a valuable part of this team. We need them to be healthy--and so do their families and friends. So while we do have incentives, education is vital to make sure they understand how important they are to our goal of delivering quality health care."
PAMELA CAGGIANELLI, RN, CDMS, CCM, COHN-S, LNCC, is chairwoman of the Certification of Disability Management Specialists Commission and manager, corporate health, for Bausch & Lomb Inc. in Rochester, N.Y.
NORMAN HURSH, Sc.D., CRC, CVE, is immediate past chairman of the Certification of Disability Management Specialists Commission, and an associate professor in the Rehabilitation Counseling Program of the Sargent College of Health and Rehabilitation Sciences at Boston University. He also directs the graduate specialization in vocational evaluation and in disability management, and is the director of vocational rehabilitation services at the Sargent College Clinical Centers at Boston University.
September 1, 2006
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