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Success stories improve willingness to try
In recent years, companies that have successfully integrated their occupational health services have reaped some considerable benefits. Despite those success stories, however, one expert says the move toward integration is not as rapid as he had hoped.
"There’s not as much traction [as I expected] and there’s still a lot of opportunity," says Howard Kraft, MA, vice president of the human capital consulting practice for the The Benfield Group, a St. Louis-based health care consulting firm that provides research, strategic planning, and implementation support. "It has happened more slowly than one might expect, even thought those companies that have done it have achieved success and value.
"When we look at the progress made over the last several years, there’s not as much integration as we would think, be it integrated health and productivity management, disability management or human capital management," he continues. "We just aren’t seeing widespread integrated strategies to improve the health and productivity capacities of employees."
This despite the fact, he says, "integration can deliver business value in terms efficiency when done well." While The Benfield Group’s clients are mostly employers, Kraft says he also works with the vendor community, helping them improve their relationships with the employer community, and he hears the same story there.
Why has integration failed to catch on? "There is not as much communication of the success stories as one would hope," Kraft offers. Those stories point to significant opportunities for employers. "The benefits these companies have seen are a decrease in overall costs, decreased redundancy and duplication of effort," he says. "For the person going through the system the experience is more seamless, there’s less confusion and better utilization of services, less cost-shifting and higher satisfaction."
Three major roadblocks
Looking more closely at the situation, Kraft identifies four major areas that present the greatest challenge for companies seeking to integrate:
1. Data/information: For most part, the different pieces of the integration puzzle have their own data systems and generate their own reports, says Kraft. "But the data in these areas are only a narrow slice of the pie," he says. "For example, we spend a lot time working with companies on their medical claims data. In some cases, prescription drugs data are not even integrated with inpatient and outpatient data, [nor is] behavioral health." In other words, he says, one of the larger occ-health buckets often does not have all the data it should.
"When you begin to expand that out to not only medical claims but to absences and medical disability data, systems may not be in place to evaluate that data on a regular basis, let alone to integrate it with the other key areas," says Kraft. "So you have decisions made based on siloed information and data systems. We suggest that information can lead to certain actions, and the consequences of those actions are not necessarily known [throughout the system] because of unintended consequences that occur somewhere else in another data system."
The news here is not all bad, says Kraft. "During the last 10 years, we have begun to clean up and improve data collection, and that’s encouraging," he says. There also are concerns among employers that by integrating data, employee privacy will be infringed upon. "But that’s an ill-conceived notion," says Kraft, "And HIPAA [the Health Insurance Portability and Accountability Act] should help in that area." Finally, he says, some vendors are not yet up to the task. "The capabilities of vendors to integrate data shows this is still an industry in its youth," he asserts.
2. Incentives: Kraft says there is a lack of alignment of compensation, bonuses and other rewards tied to performance and achievement of employee health goals, benefit plan design or safety recognition. "Different players within organizations own different pieces of the pie, and their performance is rewarded or discouraged based on siloed success," he says. "If I just have responsibility for workers’ comp my incentives are only tied to my achieving success in workers’ comp. There may be someone else in my organization tied to better management of non-occupational disability. If we have slightly different goals and rewards, our behaviors will be dictated by those differences, which can lead to problems like cost shifting. An organization, for example, with a very strong safety focus can be conducive to good success in that area, but that may not necessarily point to success in other areas."
3. Plan design: "We want our people to take advantage of the right programs for their health and productivity, but our incentive structure may not support that," says Kraft. "For example, if your coinsurance is too high it can get in the way of people being compliant with their prescription drugs. If people are verbally encouraged to use the nurse line but not rewarded, we may lose an opportunity to save money by reducing visits to the emergency room. We need to be sure we are incenting right behaviors."
4. Communication: "People don’t talk to each other enough; they don’t take the time to understand the issues and priorities of their co-workers," says Kraft. One of the reasons integration has not taken hold is that we are not sharing our goals, our targets, our priorities, our successes, and failures enough.
With large organizations, where employees can even be located in different buildings, there tends not to be regular communication. "We become siloed in our perspectives," Kraft observes. "Sometimes integration can be viewed as loss of power by a manager, that in terms of career advancement there will be winners and losers," he says. "For example, if I don’t have workers’ comp anymore, what will I have? That’s why it’s critical for people to understand what each other does, and what kind of results they are achieving.
"That’s what will bring integration forward," Kraft adds. "This must be done not only internally, but with other companies as well, in terms of sharing best practices."
[Editor’s note: This article is the first in a two-part series. In the second article, we will explore the benefits and successes seen by a company that has successfully integrated its occupational health services. For more information, contact Howard Kraft at: firstname.lastname@example.org.]