Leaders: Making the Business Case for Integrated Health and Wellness

by James L. Nash

OH: Does the traditional EHS professional have a role to play in wellness programs?

Eherts: I would argue the champion for integrated health and wellness should be EHS. There are huge synergies between health protection and wellness.

OH: Before we get to these synergies, can you explain what's in your integrated health and wellness program?

Eherts: The low-hanging fruit, when it comes to integrated health and wellness, is primary care and disability management, so this is where we began. Primary care means using an onsite clinic to handle non-occupational issues, and there's a lot of money to be saved in that area. Then there is a huge value, for the employee and for the company, in having a company doctor or health professional acting as the person's advocate in disability management.

OH: How does having onsite clinics handle non-occupational issues save money?

Eherts: If we see workers onsite for non-occupational issues, we save not only on the medical costs and the cost of processing the claim, but in productivity, because these people spend 15 minutes at the clinic down the hall, rather than 3 hours to go to the doctor. We measured this for quite a while and saw some big savings. We found two-thirds of the cases would have seen their own doctor anyway.

OH: Explain what you mean by "disability management."

Eherts: By disability, I mean workers' compensation or short-term disability, occupational or non-occupational. There is great value for a company and the employee in having a company doctor or health professional acting as the person's advocate. Let's say you break your leg skiing and are home in a cast. Normally, HR benefits would be the interface for your short-term disability benefits. What we do is insert a health professional into the relationship. When was the last time a doctor called you at home when you were sick and asked 'How can I help you?' That's basically what we do. A lot of times they will have questions like, 'I'm not using my crutches, should I?' Questions you really can't ask an HR generalist.

OH: I can see how this might help the worker how does it help the company?

Eherts: What I found happens is when nurses or doctors call you at home, and begin to discuss your case, they can say things like, 'You're very valuable to this company and we're having trouble getting along without you.' So employees come back to work sooner, and with more loyalty to the company than if you ignored them. People love to work for employers who value them. I've learned that over the last 5 years.

OH: You haven't said anything about "wellness" or health promotion.

Eherts: That's the high-hanging fruit. What's the benefit of reducing the average weight of employees, of smoking cessation? Those savings are more long-term and more difficult to quantify than disability management. But I would say right now qualitatively we know it's there. We know that a healthier work force is more productive. We're just starting to quantify this.

OH: How do you do that?

Eherts: The first two steps are a claims analysis and a good literature review of the value of wellness programs. We've done the literature review and just started doing claims analysis: Where are you spending your health care dollar? Once you have that, you can focus on things that will bring you the largest and most immediate savings.

OH: What are the synergies you spoke of between EHS and integrated wellness?

Eherts: The first role of the EHS person is to educate the medical professional on the hazards and exposures of the worksite. Doctors have a difficult time with modified duty for disability management if they don't understand the workplace.

Then the communication becomes two-way. For a lot of our sites that are very lean in EHS, having health and wellness report back to them gives them additional resources. For example, we have our doctors and nurses doing audiometry in hearing protection programs, or the medical clearance and fit-testing for respirators. Now they can do a better job of medical surveillance. If they see an elevated liver enzyme in an employee, they understand the job and the exposure and it helps them interpret the data.

Now you can get "real-time epidemiology." The medical people may see three people with pain in the wrist who all work in the same area. So they say to EHS, "Please do an ergonomics analysis of that job." You can head off potential problems.

There's one last synergy that's very important, that ties health protection, integrated health and wellness together. The savings you get in disability management comes from the relationship the medical professional has with the employee. Once that relationship is built, if the person is out on workers' compensation or short-term disability, when the medical person calls him at home the relationship is so solid that everybody works on the basis of trust and the outcome is much more favorable for everybody. Going into the workplace, doing respirator fit-testing and so on helps build that relationship.

Finally, this trust helps make health promotion more effective. If a doctor I know well tells me to quit smoking, I'm more likely to listen than if it's somebody I see once every 3 years.