Incorporating Corporate Employee Health (CEH) Programs into private practice to create the total worker wellness model.

RUSSELL CERTO, PT, OCS, WILLIAM MCCORMACK MS, PT, CSCS, AND TRACY ERVIN, MPT

Physical Therapists offering traditional Occupational Health Programs are trying to find ways in which we can expand our relevance/presence within the changing medical delivery system and grow our own businesses. One method to achieve this goal is to develop a corporate employee health (CEH) program that focuses on worker wellness. A good CEH program adds value to the traditional services (FJA, FJD, PWS, ergonomic analysis, etc.) that we are already providing to our employers, creating a total worker wellness model in which we can practice.  

CPR, in an effort to diversity our practice and stay relevant in the evolving medical delivery system, adopted the M.O.G (Medically Oriented Gym) in 2015.  The M.O.G. at CPR is part of a co-op of national clinics, providing evidenced based programming that is supported by outcomes.  The M.O.G. offers services to healthy people, as well as individuals that may be medically compromised (obesity, diabetes, heart disease, arthritis, etc.).  Through medically supervised programs that provide fitness, nutrition, education, and guidance, the M.O.G. has been able to bridge the gap between medicine and fitness, reducing health risks and health care costs through risk-reduction programming.  The programs and outcomes demonstrated by the M.O.G. set us apart from other providers in the community that are offering wellness services.

In addition to serving the general population, the M.O.G. provides specialized programs to address the needs of employers as they continue to look for innovative means of improving worker wellness and decrease the costs of health care utilization as well as worker’s comp claims/injuries.  The M.O.G. includes CEH programs focused on building and maintaining a “healthy/low risk” employee population.  These programs have demonstrated cost savings through a reduction in obesity related health conditions, injury reduction, increased productivity, and reduced absenteeism.  

It is our belief that companies that are self-insured for healthcare would benefit greatly from adopting the M.O.G. model as their employee health and wellness program. According to the Employee Benefit Research Institute 52 percent of employers are now self-insured companies.1 Because of certain provisions within the Affordable Care Act, it is estimated that over the next 5 years, 75 percent of all employees in the private sector will be covered by self-insured health insurance.2 Currently, the most common form of wellness programming provided by the employer is an online health risk assessment (HRA) whereby the employee voluntarily answers a series of questions online and the software program provides an analysis and simple strategies for improving health risk markers. In almost all instances, these self-insured employers are provided some data analysis by their third-party claims administrator or contractors but are never given appropriate or effective strategies for actually engaging employees in healthy lifestyles. We believe that physical therapy following the M.O.G. model can become the “what’s next” solution for CEH programs.

Consider these Case Studies:

• In a study of 102 chronic disease patients following the M.O.G. model, we were able to reduce the total cost of healthcare on average $4,000 per participant. This cost savings was measured against what Blue Cross Blue Shield of WNY had predicted for these patients.  Additionally in this study we were able to show migration from high risk pools to moderate risk pools. 3

• In another study, Harvard Pilgrim Health placed 66 pre-diabetic patients into the M.O.G. and after a 6 month M.O.G. intervention none of these patients progressed to a diabetes diagnosis. Research has demonstrated that 1/3 of these patients would have progressed to diabetes, 1/3 would have remained pre-diabetic and 1/3 would have managed their lifestyle and improved their health independently. In terms of cost savings, a diabetic patient will cost about $10,000 more per year than a patient without chronic disease. In terms of the Harvard Pilgrim Health study the M.O.G. intervention saved the payer $200,000. Harvard Pilgrim Health will also obtain downstream cost savings beyond the 6 months of M.O.G. intervention. 4

• In 2010, a risk-reduction study was carried out on 252 high risk firefighters in Howard County, Maryland. This study demonstrated a 40% reduction in recordable injuries during year 1, 60% in year 2 and statistically significant weight loss with an overall Return on Investment (ROI) of 4.6:1. 5

In the self-insured corporate environment these kinds of cost savings are obtainable and have proven to work at companies willing to change the culture of healthcare use and make employee health a strategic initiative. There is enough evidence that proves that a corporation can incentivize their employees to become responsible for their own health and to “partner” with the employer to make smarter cost saving decisions when the employee is in need of healthcare. It is reasonable to expect that the physical therapist embedded in a corporate environment could assist in designing and developing a better employee health plan. The role of the PT is not just in terms of workers comp/work site injury and employee health intervention, the onsite PT could be seen as the CEO of the healthcare department. The final step in developing an all-encompassing employee heath model would be to bring Primary Care Services into the workplace, to manage and stay ahead of chronic disease.

Self-insured companies are perfectly positioned to take advantage of the M.O.G. model, however those companies that are not self-insured can also benefit. Working with the M.O.G. and the insurance company, strategies can be developed to use claims data that would drive down the total cost of care for employees, reward them with deposits into Health Savings Accounts and share the savings between the Employer and the Insurance Company.  Risk reduction analyses have demonstrated significant impact of the health and well-being of employees. If a company is trying to slow the rise of healthcare costs among their employees, especially for those with moderate to high-risk preventable diseases like pre-diabetes, diabetes, obesity, cardiovascular disease and even cancer, the M.O.G. can help.

In addition to the CEH programs, bringing on the M.O.G has allowed for flexibility on the traditional reactive side of our Physical Therapy practice in regards to the Worker’s Comp arena.  The M.O.G. has programming that serves workers that are recovering from injuries.  This program, called the REALM (Rehabilitation, Exercise, and Life Management) program, creates a bridge between skilled PT and full time return to work.  It allows for continuation of a supervised exercise program once the injured worker is no longer in need of formal PT, but is not yet ready for full RTW.  It provides exercise and work conditioning activities specific to the unique medical and musculoskeletal issues of the individual, to help prepare the injured worker for a safe return to full time employment.  This program can be provided at a fraction of the cost of continuing traditional PT and/or work conditioning/hardening.  Employers, physicians, and insurance companies have quickly realized the value of this program as a tool to help control the overall cost of claims, yet realize successful outcomes.  

Through the adoption of the M.O.G., with its innovative programs to assist with corporate employee wellness and bridge programs for RTW, coupled with our current traditional occupational health programs and partnerships with WorkWell, CPR can now offer employers the total worker wellness model. These programs are based on best practices, are evidence-based, and produce the outcomes needed to set our clinic apart from a very competitive market in an emerging new healthcare model.  We all recognize that if we do not adapt to changes in health care, we will become irrelevant and our business will struggle. As a group, we have realized that we can make a difference by providing appropriate exercise to medically compromised patients who cannot be served by the neighborhood fitness club and the local YMCA. We are the experts at delivering these medical fitness prescriptions and we are accepted members of the health care delivery system. Our growth in private practice for the single entity office and for the large multisite physical therapy business is in coordinating lifestyle management services that drive the cost of care down, flattening the cost curve, and sharing in those cost savings. These opportunities provide us another chance to serve our communities, work within the medical delivery system, and maintain our presence, relevance, and standing within that system.

Russell Certo, PT, OCS, of MOG at Grand Island Physical Therapy PC. He can be reached at1themog@gmail.com.

William McCormack MS, PT, CSCS, of MOG National. He can be reached at bill@mainemog.com.

Tracy Ervin, MPT/Owner at CPR (Center for Physical Rehabilitation).  She can be reached at cprtracy@gmail.com

REFERENCES

1. Employee Benefit Research Institute. www.ebri.org/pdf/briefspdf/EBRI_IB_413_Apr15_RCS-2015.pdf. Accessed November 2015.

2. Employee Benefit Research Institute. www.ebri.org/pdf/briefspdf/EBRI_IB_413_Apr15_RCS-2015.pdf. Accessed November 2015.

3.  Data from a study conducted in partnership with Blue Cross and Blue Shield of Western New York, Sheridan Medial Group, and the M.O.G. evaluating 150 insured individuals categorized as High Cost/High Risk (HCHR) as defined by multiple chronic co-morbidities

4.  Data from Pre-diabetes Prevention Study in direct partnership with InterMED (physician owned medical facility), Harvard Pilgrim Health Care, and the MOG.  Results were indicative of 54 patients enrolled in MOG programs over 6 mo.

5. J Occup Environ Med. 2010 Mar;52(3):336-9. Implementation of a physician-organized wellness regime (POWR) enforcing the 2007 NFPA standard 1582: injury rate reduction and associated cost savings.