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Onsite health programs, wellness to get boost
Reimbursement is the reason
All signs in health care reform point to preventive incentives. Paul Papanek, MD, MPH, chairman of the board for the San Francisco, CA-based Western Occupational Environmental Medical Association and former chief of the occupational health service for the Kaiser on the Job Program in Los Angeles, expects to see these changes in occupational health as a result of health care reform:
Employers will be more likely to implement wellness initiatives. Employers may now be hesitant to spend extra money on prevention programs, says Papanek, but they'll be more likely to implement these approaches as a result of health care reform. This, he explains, is because workplace preventive services, including health risk assessments and other health and productivity interventions, are more likely to be reimbursed by insurers.
"The employer will have an incentive to ask you to do that, because those services are going to be paid by the health plan," he says. "The employer is more likely to implement such services, because there aren't any short-term costs."
There will be a shortage of occupational medicine physicians. "We are going to have a health personnel shortage in occupational medicine in the next few years, in my opinion," Papanek says. "That means we're going to have to train way more occupational medicine physicians."
There will be different rules for health plans under the Health Insurance Exchanges to be set up by the states, than for employer-sponsored plans. Papanek points to a recent study which estimated that after 2014, 60% of Americans are still going to be covered by employer-sponsored plans.1
"Some predictions were for a bunch of employers leaving in droves, but it doesn't look that way," he says. "It's still going to be a pretty big chunk."
Papanek notes one section of the Patient Protection and Affordable Care Act (PPACA) says that employers are permitted to give cash discounts on premiums or copays, provided that the enrollee meets certain health targets. "These are permitted to be very broad," he says. "We are now smarter than we were ten years ago about what kind of preventive measures work. If you take your migraine pills, you are more likely to show up at work."
If the insurance carrier offers incentives for enrollees who meet benchmarks, says Papanek, this means that somebody has to make a decision about which chronic conditions will be targeted.
"Somebody has to be looking at what measure you are going to target. Then you can make a decision about rate setting," he says. All of this means a bigger role for occupational health, according to Papanek.
"As we work with employees to try to get their health behaviors and risk factors to improve, we are going to end up being benefits administrators," says Papanek. "We are talking about hundreds of billions of dollars flowing through occupational medicine."
This is good news, both for employees and the company's bottom line, says Papanek. "All of these forces are converging on occupational medicine doing its job way better than we do it now," he says.
Workplace services will need to be integrated with medical homes.
If you give a worker influenza vaccine, for instance, this will need to become part of the employee's medical record, says Papanek.
Smaller companies will be able to apply for grants.
Papanek notes that the PPACA includes grants for companies with less than 100 employees to offer preventive services. "Small employers are not going to be in a position to do that without help," he notes. "So an additional role for occupational health is to be grant writers for some of those programs."
Preventive services will become more common.
If you ask an occupational medicine physician today what percentage of his or her income comes from preventive services, as opposed to workers compensation or injury care, says Papanek, it's likely to be a very small percentage.
With the onset of PPACA, he says, "the percentage of the income stream is going to swing way over. We will get a bigger stream of our income from doing preventive services. There is going to be plenty of money over there, and there should be."
1. Eibner C, Hussey PS, Girosi F. The effects of the Affordable Care Act on workers' health insurance coverage. N Engl J Med 2010;363:1393-1395.