I recently attended the HIMSS conference, an annual and massive gathering of health information technology professionals focused largely on the use of IT in traditional healthcare delivery channels.
This year, “population health” was all the rage as healthcare providers scramble to procure and deploy technology that can identify and manage their most vulnerable (and generally most costly) patient cohorts. This emphasis on population health is driven largely by shifting payment models with a focus on paying for outcomes rather than procedures.
Ironically — hospitals, clinics and practices are struggling to put in practice something that employers are all too familiar with — the need for sophisticated health surveillance, ideally assisted by information technology applications.
At Enterprise Health, the medical surveillance capability embedded in our applications has traditionally been driven by client job functions and locations. For example, Fred works in Plant 7 where he drives a forklift and is exposed to noise and certain chemicals. We receive a feed from a client HR solution with this information, and Fred is automatically enrolled in surveillance panels to make certain he has a regular audiogram, respirator fit test, blood test and driver fitness exam.
As Fred becomes due for those tests they are automatically ordered by protocol, generating an email with an invitation to visit an employee portal where he can schedule his appointments and complete pre-appointment questionnaires. For recurring appointments, the portal is populated with previous answers from historical questionnaires and Fred can make quick updates. Fred’s clinical testing from the health clinic is documented in the Enterprise Health solution, and proof of compliance is recorded for OSHA. All of this sounds like population health in a workplace setting and employers have been doing it for decades.
It is well understood by most large employers that a small percentage of employees with a handful of chronic conditions tend to consume an outsize share of the healthcare spend — a major source of concern for self-insured organizations. Increasingly, research shows that employees with conditions including heart disease and diabetes are at greater risk for acute occupational injury — another costly hit to productivity and the bottom line.
We are working with our clients to recalibrate our health surveillance functionality to support this move to enhanced primary care in the workplace. In this case, the aforementioned Fred might have diabetes, hypertension, hyperlipidemia — or some other chronic condition that affects not only his health, but his likelihood of worksite injury. Fred could elect to enroll in a voluntary diabetes management program, which would automatically place him in a health surveillance panel tied to his condition. Rather than reminding him to schedule an appointment for a respirator fit test or audiogram, we would notify Fred when he is due for a foot exam, eye exam, or A1C test.
Using already established health surveillance infrastructure, Fred’s employer is able to help him manage his diabetes. If Fred is healthier, he is more likely to fall into the present and productive employee category. The annual healthcare cost for a compliant patient with diabetes is a fraction of the medical spend on a non-compliant individual. Add in enhanced avoidance of a costly worksite injury — and it quickly becomes clear this is an outcome worth paying for.