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Jerry Heit
WorkSMART Occupational Health Clinic
2501 East 13th
Hays, KS 67601
Phone (785) 623-4942
Fax (785) 623-4792

Rural Kansas is hardly the place one would imagine for a successful integration of prevention, wellness, and occupational medicine. If large, big city employers are not always willing to pay for wellness and prevention services, why would farmers and rural manufacturers? Hays Medical Center, located in Hays, Kansas, is a pleasant surprise and a reflection of the growing paradigm shift occurring in health care: more employers are recognizing the benefits of prevention, more individuals are taking responsibility (and control) of their health, and more and more providers are stepping up to the plate to create new and innovative ways to reach customers and be responsive to consumer demand.

Located in northwestern Kansas, halfway between Kansas City and Denver, Hays Medical Center is a 147 bed hospital serving a rural population of about 25,000 locally and 130,000 regionally. Hays Medical Center recognized that it was imperative that it reach the surrounding population in as many ways as possible. Its occupational health program was one strategy the organization developed to target the working population.

Two years ago, one of the larger Hays employers approached the occupational program about performing Health Risk Appraisals (HRA) in conjunction with their yearly physical exams. "As a SYSTOC® user, the logical place for us to start was with the HRA application within the software," notes Jerry Heit, RN, Program Director. "After success with our first customer, we decided to package the HRAs and sell them as an add-on to basic wellness screenings." Employers have a choice of two HRA packages. One includes the HRA, blood pressure check, and extensive lab work. The other package includes the above along with an optional PSA (for males), a medical history, Body Fat Analysis, resting EKG, stress EKG, and pulmonary function test.

Jerry meets with each company to verify which package will better meet its needs and budget. Then HRA forms are given to the company representative to distribute to employees for completion prior to their appointment. A date is set for a Nurse Practitioner or RN to return to the company for the first visit with employees. During this first visit, blood work is drawn and the physical exam and any other services are performed. Employees are expected to bring their completed HRAs to their appointment and also fill out the basic medical history, which is standard with all physical exams.

Once the HRAs are analyzed and lab results are back, a second visit is scheduled with each employee and the original provider. This appointment is usually scheduled about a week after the first appointment and all HRA, lab and EKG results, and any identified risk factors are discussed thoroughly with each patient. The typical follow-up counseling session usually lasts about ten minutes, depending on the number and severity of risk factors and questions the patient might have. All patients are given a copy of their HRA and medical test results, which they can take to their personal physician. Patients requiring additional medical follow-up, intervention, or wellness counseling are always referred to their family physician or other appropriate provider and are monitored yearly for success.

All of the employers who participate in the Hays HRA program provide the HRAs and physical exams on a yearly basis to all of their employees. According to Jerry, "This allows for monitoring of individual as well as company wide progress and yearly reporting to both the employee and employer. With SYSTOC® data entry, record keeping and tracking is easy at both the company and patient level. We are able to produce reports that track trends and outcomes, which is further demonstrating the value of this service." Employees are then awarded "wellness" points based on their answers to the HRA and their progress toward individual goals. Employers are provided with summary data for their company, showing overall company trends and improvements. Individual employee results are never provided to the company and patient confidentiality is a top priority for Hays and the employer.

"In addition to the company specific report," notes Jerry, "we provide the employer with a recommended education plan for the year, which is targeted to the company’s identified or most significant risk factors. Then the company selects the educational components it would like delivered over the next year by Hays. These educational sessions are usually tied to Safety Committee Meetings or other company initiatives, are offered at an additional charge, and are made available to all employees. This reinforces individual patient education and allows the whole company to be focused on the same health and wellness goals." Often, Hays is able to tap into the resources of national organizations such as American Heart Association or American Cancer Society for materials, which minimizes their "development" costs and also allows the hospital to partner with national or local organizations.

For one client alone, the program has identified three workers with substantial cardiac risk. Hays has worked with these patients and their employer to create a successful, preventive intervention strategy that has included smoking cessation, weight reduction, nutritional counseling, cholesterol/triglycerides monitoring, and cardiac awareness. All three workers have made significant progress in reducing their cardiac risk factors. Another client, an older worker who was also a new hire, was found to be diabetic and at cardiac risk. The patient had been experiencing declining health and eyesight for several years but attributed the decline to the natural aging process and never sought medical care. Hays was able to connect the patient with a family physician, and he now has his diabetes under control and is managing his cardiac risk factors.

Jerry has found these services easy to sell because "Many employers understand the fundamental value of wellness programs and keeping their workers healthy. Success stories like these make the programs even more popular, because risks are always identified and we work with the company and the employee to better manage these risks and make improvements that they want to make. We work with them to identify their priorities for change and the resources available to implement those changes. We make the suggestions, but the final decision is up to them. We are now entering our third year of offering HRAs and the companies that have used us during the last two years are beginning to see improvements from the HRA and intervention programs."

Some programs would find this approach too time consuming, but Jerry feels that it is no more time consuming than any other service they perform and that it allows the occupational program to be a true partner with its corporate customers in creating a healthy workforce. It also allows the occupational program to be involved in those improvements over the course of each year, further solidifying the bond among the program, hospital, and local employers. "By going on-site, we also create convenience and improved participation in the program. In a rural community, it is essential that we go to the work site, since some of these companies are quite a distance from the hospital. If they had to send everyone into town for their wellness programs, they probably would not be as interested—it would just be too time consuming."

Improving the health status of the populations we serve is the fundamental mission of all health systems. We sell and provide health. Historically, much of the health system has been set up to be reactive rather than proactive, delivering care after illness or injury has occurred. As consumers and employers come to understand that about 75% of all health conditions are life style related and can be minimized or prevented by appropriate and targeted interventions, more and more consumers are willing to pay for prevention. Furthermore, as the labor market becomes tighter, employers will be looking for ways to attract and keep valuable workers.

Increasingly, today’s health care consumer wants to be educated, kept informed, and be an active participant in treatment, recovery, and health decisions. With so many of the working population passing through occupational programs, health systems may be overlooking one of the most effective consumer markets to target! In fact, national studies show that about one-fourth of all individuals do not have health insurance and/or do not have a relationship with a family physician. In many markets, identifying at-risk populations will, in part, have to fall under the scope of services offered by the occupational product line, because for a large percentage of the working population this may be their only encounter with the local health system.

Many employers want to be able to do more for their employees, understanding that prevention contains costs and provides a return on investment. Prevention programs also enhance existing benefit packages and can be one of many endeavors that form their recruitment and retention strategies. Occupational health can be one of the health system’s best avenues into prevention and wellness, and the use of this approach will undoubtedly escalate. Hays Occupational Health Program is a great example of how healthcare will be delivered in the future. .