MANAGED CARE May 2003. ©MediMedia USA
Businesses are relying on doctors to direct the health benefit. They often work directly with plans to keep workers healthy — and at their posts.
As the corporate medical director for Bank One, Wayne N. Burton, MD, travels around the country meeting with health plans to devise strategies to keep the Chicago-based financial services company's employees healthy and productive. Health plans in Indianapolis and Detroit have worked with Burton to design educational seminars on chronic diseases for employees. And last year, Burton talked health plans into paying for 7,000 Bank One employees to receive on-site flu shots.
Twenty years ago, such interaction between a corporate physician and insurers was unheard of. Physicians who specialized in occupational medicine wore white coats, slung stethoscopes around their necks, and busied themselves with workplace safety issues.
A majority of corporate medical directors today, however, are charged with thinking about the health of their employees both inside and outside of work, Burton and other corporate medical directors say.
"Companies have done a good job of reducing health threats such as smashed fingers and other traumas at the workplace," says Mark A. Roberts, MD, PhD, corporate medical director at BP, formerly known as British Petroleum, a London-based energy company that does plenty of business in the United States. "We still deal with safety issues and we'll always have to, but now we are also dealing with lifestyle issues: smoking, diet, exercise, and an aging work force."
Growing influence
Increasingly, as their roles evolve, corporate medical directors are turning to health plans for help. They are asking insurers for utilization data on their employees as well as assistance in designing and executing wellness programs. Such efforts are part of physicians' growing influence in the benefits, or human resources, areas of companies, where they traditionally had not been involved. BP's Roberts and others are still developing relationships with their HR departments and insurers, Roberts says. "I'm learning a lot about the ins and outs of health plans." Some corporate medical directors have taken on major roles within HR departments, however.
As vice president for medical services and benefits at Hughes Electronics, based in El Segundo, Calif., Pamela Hymel, MD, oversees administration of all benefits for the company. Having a physician in the position "is an innovative approach," she says.
In her role, Hymel has worked with health plans on several large initiatives. One project coordinates the company's disability management program with health plans. The program requires managed care organizations to make sure their providers consult with Hughes's disability managers to get employees back to work as soon as possible. Hymel has initiated wellness programs with HMOs as well.
In one pilot program in Boise, Idaho, Hughes has asked Blue Cross of Idaho and Aetna to work with Health and Productivity Corp. of America to shore up employees' use of the health care system.
"We were finding that our medical care utilization was a lot higher in the Boise area, and so we are trying to work with both the providers and employees on when it is appropriate to access medical care and how to get appropriate care in a timely manner," Hymel says. The program also looks at how to get employees back to work sooner when they're disabled, and it invites employees to take health risk appraisals to identify chronic problems and participate in wellness and risk-reduction programs.
The Blue Cross health plan's role has been to provide employee-specific claims data to Health and Productivity Corp. of America, which is administering the program, and to provide access to providers in the area, Hymel says. "We are working with the providers to help them understand that we are trying to improve the health of our employees."
If the program is successful, Hughes could implement it in other areas where the company has a large number of employees, such as Maryland and southern California, Hymel says. She hopes health plans will take part, she adds.
Hymel hasn't always been successful in working with HMOs, she says. The company has initiated many wellness and disease management programs through its self-funded PPO and point-of-service plans, administered by Aetna, that it has not been able to duplicate with contracted managed care organizations.
"We wanted to offer the same wellness opportunities to our HMO participants but also wanted the HMOs to offset the costs of the programs, and they have not been willing to take on that role," Hymel says. "We haven't been as effective in getting some HMOs to buy into our strategic initiatives."
Challenge: Getting baseline data
Obtaining baseline data on employee health from HMOs has also been a challenge, she says. "We have had to fragment our program between employees in our PPO plan — which is about 55 percent of our population — and employees in our HMO plans because we cannot get pertinent medical data for our employees in these HMO plans. And we don't want to put in programs that we can't measure for effectiveness."
Gathering data from insurers has long been a concern for employers. When Burton was hired in a groundbreaking role to work with Bank One's benefits department 20 years ago, seeing where the company's health care dollars were being spent was his first priority. By the mid-'80s, Bank One had programs in place to provide prenatal education for women and to change the primary focus of its mental health programs from alcohol and drug rehabilitation to care for depression — both areas where insurers had helped the company identify large expenditures.
Today, corporations such as Bank One are evaluating insurers based on their willingness to work with the companies on a variety of projects. "When we send out our request for proposals each year, there's a section that says, 'This is what our corporate medical director is interested in; please tell us what you can offer and how you can offer it,'" Burton says.
Collaboration is a two-way street, and it's increasing rapidly, he adds. "The health plans and their medical directors are very interested in talking with us about the kinds of disease management and health promotion programs that they have, so that we are aware of them and can take advantage of them. I get calls frequently. I just had a call from one of the major plans we offer, and we'll be meeting with their national medical director to explore other ways we can work together."
Those calls are coming at a time when the roles of health plan medical directors are evolving as well (see article in Managed Care, March 2003 [1]). As the emphasis changes from utilization management to consumer education at Cigna, for instance, the insurer's field medical directors are being asked to work with clients to customize wellness programs for their employees, says Andrea Gelzer, MD, MS, vice president for health policy at Philadelphia-based Cigna.
Health plan and corporate medical directors have a lot in common because they are both concerned with population-based medicine, even though they are looking at different populations, physicians say. "When I look at a sore elbow, I think, how many other people may have similar symptoms and why is this happening?" says BP's Roberts.
Getting health plans to help address such concerns is important, he adds. "The number one thing companies are doing right now with work forces is reducing them," he says. "They are trying to do more with fewer people. So we need to keep those people as healthy and productive as possible, both on and off the job."