HFMA VIEWS

Scott MacStravic, PhD

I read an article yesterday that caused me to ask the above question of hospitals in general. It described how Florida Power & Light (FPL), a major employer in that state, began an employee wellness program called “FPL-WELL” in 1991, beginning modestly with some health promotion initiatives, adding an exercise facility, then opening its first onsite medical clinic in 2000.  The first clinic proved so successful that it opened a second in 2003 and a third in 2005.

The first center was initiated with the help of a local hospital, which operated it for its first few years, but could not keep up with challenges in resources, technology and staffing. As a result, FPL contracted with Whole Health Management (WHM) in Cleveland, Ohio, a specialized supplier of occupational and corporate health services. When FPL planned the second clinic’s opening, it approached “four or five” local hospitals about running that clinic, but: “They weren’t able to make the connection about how it related to their core business.” according to Andy Scabelli, FPL’s manager of employee health and well-being. A proposal to use medical residents and interns to staff the clinic also fell on deaf ears at the area’s medical school.

As a result, FPL went again to WHM. Hospitals have a similar “core business” choice when it comes to their own employee health. They can ignore it, or deal with it modestly within the confines of health insurance and Employee Assistance Programs. They could develop and operate their own programs, such as the “Fairview Alive” program offered by the Fairview Health System in Minneapolis. This program has been reported to have saved the system several millions of dollars in workers compensation, absence and turnover costs. [B. Eischen “Impact of Wellness Programs: Fairview Health Services’ Experience” National Forum on Health, Productivity and Absence Management 2003 (www.ibiweb.org/forum-presentations/9)]

Numerous hospitals have developed disease management centers, particularly for diabetes, to reduce the crises, complications and worsening thereof. Hundreds offer executive health programs, fitness centers, and other health-focused initiatives, even though these conflict with their interests in gaining revenue from sickness care. But employee health management, for themselves, or as a revenue-generating “sideline”, is easily the greatest opportunity to both benefit the economy as a whole, and gain profitable revenue.

So why is it not a “core business”? Wheaton Franciscan Healthcare, Milwaukee, Wisconsin, has been partnering with Quad/Graphics, a large, local printing firm, in a joint venture called “QualMed”, which operates eight onsite employee health clinics in the US. It also staffs onsite clinics at two other locations in its market. Because of its close working relationships with local employers, it enjoys a “preferred provider” status that delivers extra patients, or reinforces current patients’ preferences for inpatient and outpatient sickness care.

Both St. Luke’s Health System in Sioux City, Iowa, and the University of South Florida’s USF Health are partnering with U.S. Preventive Medicine® in sponsoring preventive medicine services for consumers and The Prevention Plan for employers.  These programs include health risk assessments and extensive diagnostic testing, along with coaching and medical care, where needed, to improve the health of employees, generate added use of the hospital’s diagnostic and treatment services, and generate added wellness revenue.

The Pratt Diagnostic Center at Tufts-New England Medical Center in Boston offers its own “retainer medical practice” in concert with MDVIP. This practice, like all MDVIP practices, stresses wellness and proactive health interventions, which have been shown to significantly, often dramatically reduce the use of reactive sickness care among their patients. While it is true, and the deliberate intention of proactive wellness services that sickness care need, demand, and expenditures should be driven down as a result, it may be that such services belong in the core business of hospitals, if only to join with all other stakeholders in health care to reduce this increasingly unaffordable burden.