The Logic of Integration

Integrating occupational health and employee assistance services just makes sense, for they have the same objective.

I smile whenever I see a program that integrates occupational health and employee assistance services. Having considerable exposure to both of these disciplines, I can see the sheer logic behind integrating them. After all, both service categories are based in the workplace and have the same overall objective: to improve the health, well-being, and performance of the workforce. They simply focus on different areas--employee assistance addresses behavior, while occupational health addresses medical and safety issues.

Furthermore, studies indicate that behavioral issues, specifically depression, can adversely impact treatment compliance for both workplace disability and chronic disease cases. It just makes good sense to involve the Employee Assistance Program (EAP) early in identifying and treating occupational health cases that may be at risk for depression. This should improve outcomes and help employees who are out on disability or worker's compensation to return to work faster.

Lately, I've been noticing the integration phenomenon is happening more often. Is integration of employee health services becoming a trend? Are employers embracing a more holistic approach to occupational health care, one that recognizes the impact of behavior on managing disease and injuries? Are they looking at service integration as one way to improve outcomes and reduce costs? Or all of the above? I posed these questions to several experts in the fields of occupational health and employee assistance.

The Case for Integration
Dennis Derr, MA, CEAP, SPHR, a leading behavioral health and workplace well-being consultant with Signature Resources, believes occupational health and employee assistance professionals can and should make beautiful music together when they practice what he calls Integrated Health and Performance Management (IHPM). IHPM aligns health promotion and treatment to a company's overall performance objectives, such as reducing health care costs. According to Derr, "a well integrated group of services should ultimately result in lower absenteeism and turnover, improved productivity, reduced time away from work for disability and worker's compensation cases, and improved resiliency and hardiness of the workforce in general."

Derr cited several companies that have had some success in this area, including IBM, Bank One, Johnson & Johnson, and International Truck and Engine Corp. "These companies are all focusing on health advocacy, aligning all services to one major objective . . . the continued improvement of employee health," he said. "They are investing in the routine maintenance of their employees just as they do in their facilities and equipment. It's a proactive approach that is working. Johnson & Johnson, for example, estimated savings of at least $1.9 million annually through decreased medical costs, reduced sick leave, and increased productivity."

John Maynard, Ph.D, CEAP, who is chief executive officer of the Employee Assistance Professionals Association (EAPA), agrees both EAP and occupational health professionals should be working together to help employees and the workplace function more efficiently. "We should embrace the role of human capital in achieving corporate success and look for ways to help employers get maximum value out of their employees," Maynard said.

Working with occupational health professionals to manage disability cases is one way the EAP can be very beneficial, according to Maynard. For example, the EAP can identify disabled individuals who may be in a depressed state that is affecting their ability to recover in a timely manner. In addition to counseling these individuals, the EAP can reach out to other disabled workers to communicate their employer's concern and support.

"When outreach calls are made telling disabled workers their companies care about them, people come back to work faster," he said. "The measure of our success as occupational health and employee assistance professionals should be based on how well we can reduce time off from work and disruption to the workforce."

Obstacles to Integration
Although integrating occupational health and EAP services can have some very positive consequences for the workplace, there are some obstacles in the way. According to Derr, a major change in our health care culture is necessary for integration to happen on a broad scale.

"Most health care today is still being provided in a carve-out environment where services are separated and provided by different vendors," he said. "These health care programs or silos may stand next to each other in the service continuum, but they don't necessarily interact or coordinate their services well. This may be a turf issue, or it could be that silos are just too narrow in their scope with little opportunity for health care professionals to develop a holistic point of view that considers a variety of different interventions working together to improve health."

However, there is some evidence the carve-out may be on the way out. A recent survey of employers showed that in 2002, 33 percent were interested in integrating health services, up from 10 percent in 1994. Experts predict this number will rise to 62 percent by 2007. Employers may be championing the trend toward integration.

Keys to a Successful Integration
Most experts agree integrated health programs must have a corporate champion if they are to be successful. Derr calls this person a "mega manager, someone with vision, talent, and a strong desire to innovate, someone with a passion for integrating medical and behavioral health services to manage disease effectively and promote health and well-being."

Essentially, the mega manager would be a corporate medical director or senior health administrator whose job description would call for ongoing interaction with the senior management team to align health services with the company's overall performance objectives.

In addition to having a leader or champion, MEDSTAT and The American Productivity and Quality Center identified the following strategies for ensuring an effective integrated program:

  • Health promotion and productivity programs are aligned with business strategies,
  • Team members are enthusiastic about developing and championing health and productivity programs,
  • Senior management buys into the program with appropriate resources allocated,
  • Business operations managers are key members of the team,
  • Wellness and health promotion staff members are heavily involved, supporting a healthy company culture,
  • Research and outcomes programs are set up to demonstrate the link between productivity and health, and
  • A corporate consensus exists that improving the quality of work/life will improve productivity, and cost savings will result.

An Integrated Program Success Story
An integrated program that has incorporated many of these strategies is the Vanderbilt University Center for Health and Wellness, whose sole mission is to protect and support the university's most valuable asset: its faculty and staff. The center integrates four major programs, including:

  • Occupational Health Clinic, which emphasizes a safe work environment through a walk-in clinic for work-related injuries and illnesses, acute care by appointment, prevention programs, and more.
  • Work/Life Connections EAP, which provides confidential assessment, problem-solving, counseling, and referrals for employees with personal or job-related problems.
  • Health Plus, a comprehensive work site health promotion program of facilities, health risk assessments, and exercise programs to develop healthy lifestyles.
  • Child Care Centers that provide quality care and early childhood education for the children of faculty, staff, and students.

These programs have combined continuous quality improvement and the scientific method to create projects that drive decisions about how occupational health and health promotion activities are conducted and prioritized. The activities of the Center for Health and Wellness, along with the commitment and dedication of its director and staff, were responsible for Vanderbilt achieving national recognition for its employee health program. In 2002, Vanderbilt University became the first academic institution to receive the prestigious Corporate Health Achievement Award presented by the American College of Occupational and Environmental Medicine. This award recognizes North American corporations and institutions excellence in health, safety, and environmental management.

Mary Yarbrough, MD, MPH is Vanderbilt's answer to the "mega manager" or program champion referred to by Dennis Derr and MEDSTAT. As the director of Health and Wellness, Yarbrough is responsible for the four programs under the Center for Health and Wellness' umbrella. She works with the managers of each of these programs to make everything blend from both health promotion and risk management perspectives.

"Regarding health promotion, the services of our four programs are tied in more at the front end of care with a preventive focus," she said. "For example, we work together to identify why people are getting hurt, sick, or depressed and provide education, training, and medical services to prevent the problems from happening.

"From a risk management perspective, we look at how our services will not only meet the needs of our faculty and staff, but also address Vanderbilt's issues around employee retention, absenteeism, presenteeism, and productivity, as well as worker's compensation, disability, and health care costs. Finally, we measure the outcomes of all of our services to see if they have met our health promotion and risk management objectives."

Leading the Charge toward Integration
There is evidence that both occupational health and EAP providers are seeking to integrate their services. For example, Whole Health Management already provides employee assistance as part of its service array, while AspenMed Services, Inc. is exploring the advantages of partnering with a nationally recognized EAP.

President David Shinton said AspenMed is interested in bringing only the highest-quality services to customers. "Since occupational health is our core competency, not employee assistance, we prefer to partner with a provider that has a long and successful history of providing EAP services. By doing so, we can give our customers the best of both worlds," he said.

Magellan Behavioral Health, the largest managed behavioral health organization and one of the largest EAP providers in the United States, already has client relationships to provide EAP services within an occupational health environment. The company also is working on programs that integrate EAP services with a variety of workplace medical services, including disease management and disability management programs. Toni McClure, MSW, LCSW, ACSW, CEAP, Magellan's CMC Midwest Clinical Officer, suggested EAPs should act as consultants to employers, helping them to determine their employee health and wellness objectives and aligning these objectives to performance.

"The EAP should also be proactive in helping employers to define the roles and responsibilities of human resources, occupational health, and Employee Assistance Programs in meeting these objectives," she said.

This article originally appeared in the April 2004 issue of Occupational Health & Safety.

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