Potential new career path for wellness professionals gains steam
February 1, 1998 6 minutes read
Potential new career path for wellness professionals gains steam
Is trend a boon or a threat for health promotion professionals?
Health maintenance organizations have touted the benefits of wellness for years, but apparently many are putting their money where their mouths are when it comes to staffing. According to one national survey, the number of health educators employed by managed care organizations (MCOs) has tripled during the past year.
Will this trend mean career opportunities for wellness professionals or simply the shifting of employment patterns? Experts interviewed by Employee Health &Fitness give a mixed verdict. But one thing is for sure: It’s a trend that bears watching.
The evolving partnership between health promotion and managed care was underscored recently by the dramatic findings of a survey of 1,000 managed care organizations.
The survey, conducted by Warren Surveys of Rockford, IL, contacted more than 1,000 MCOs. Respondents representing 146 plans identified a total of 356 employees as "health educators." (For more details, see the chart, p. 14.)
"Last year, that number was less than 100," notes Bill DeMarco, MA, CMC, president of Rockford, IL-based DeMarco & Associates, the management consulting firm that is the parent company of Warren Surveys. He notes that Warren, a research group specializing in health care, has been conducting these surveys for 15 years.
"What we see [in the survey results] is a return to the classic definition of why HMOs work," says DeMarco. "The concept of managed care has been corrupted by many insurance companies whose main income sources have been charging premiums and denying claims. Most HMOs have made money by charging premiums and managing illness."
Encouraging a healthy lifestyle among employees can avoid 40% to 60% of typical health care costs, he asserts, and allows an HMO to manage the population at a lower premium level. "Insurance companies never had an incentive to do that, but HMOs do; they have a direct relationship with providers," he explains. "If they are rewarded for health education, then that becomes the mission of the health plan. We are being called back to the classic definition of health maintenance."
Chuck Reynolds, practice leader and senior consultant with The Benfield Group, a St. Louis-based health care consulting firm, says his own experience mirrors the trend reported in the Warren survey. "I think what we’re seeing is a natural evolution," he says. "As the markets in which MCOs operate mature, they get beyond the business of establishing their financial structure to move beyond the core of processing claims." Noting that the industry is still "fairly young," Reynolds says he would not be surprised to see continued growth of this trend in the next six to 12 months.
"I’m not surprised, from the standpoint that the MCO market is getting tighter and more competitive. This is one means by which differentiation is occurring," adds Benfield consultant Scott Kinzer. Also, employers are demanding more services from their MCOs.
Marsha McCabe, MS, health promotion manager for Richardson, TX-based Texas Instruments, says this trend has already had an impact on the size of in-house wellness staffs because of the need for companies like hers to be globally competitive. "You need just the right amount of resources," she explains. "One way to extend’ your staff is to work in partnership with outside providers; it’s a growing trend."
Where does that leave us?
As this trend to in-house health educators continues, experts agree it will have an inevitable impact on corporate health promotion professionals. What they can’t agree on is exactly what that impact will be.
DeMarco sees a real threat to the job security of current wellness coordinators. He tells the story of an HMO that was originally owned by a hospital. "They closed the sixth floor because they didn’t need the beds, and now the HMO resides there," he notes. Several rooms downstairs were converted for therapy, rehab, and the health educator. "What happens is, you actually have the hospital doing the training and the HMO reinforcing that training," DeMarco explains. "It makes more sense to have the educator work for the health plan, with the ability to reinforce what is taught. The problem today is that some wellness professionals are out doing health fairs or unnecessary screenings the HMO won’t pay for."
DeMarco also sees an inherent conflict of interest when the health promotion professional is an employee of the company. "A corporate individual who has knowledge about an employee concerning a health issue that is impacting his job may feel compelled to report him," he asserts. "But if you contract with the health plan, your contract includes a guarantee of privacy, so the employee gets the service he needs in complete anonymity."
Kinzer is not sure if the growth of in-house MCO wellness professionals spells trouble or opportunity (to work for the MCOs) for corporate wellness directors. He suspects it will do both.
"I don’t know if I would say it opens up a new career path as much as a new context by which health promotion professionals will provide their expertise," he says. "And it will progress relative to the geographic region; where MCOs are more progressive, there will be more health promotion professionals on board. If not, you’ll either see a contracting out of wellness services or the use of an inside employer group. A lot of the future depends on how managed care progresses in the prevention arena who will take responsibility for wellness services?"
"If you run a corporation that is already paying someone to deliver some level of health promotion services, you want that individual or organization to be somehow accountable, and there’s no reason to duplicate services," notes Reynolds. "At some point in time, there really will be an impact on employer-based wellness professionals, but for that to happen, the employer must hold MCOs accountable for health promotion."
Still a need for internal staff
And that’s where the wellness professional comes in, McCabe insists. "My personal viewpoint is, I don’t think of [MCO wellness educators] as a threat there still needs to be someone in your internal staff, even if it’s small. Each organization is uniquely different in terms of culture and the way things get done. Besides, you need a content expert to make sure that the outside provider performs to the standards that have been set."
A successful corporate wellness program must successfully address the issues of pro-gram design, performance, and continuity of resources, adds McCabe. "And none of that will happen without an internal wellness professional."
McCabe notes that she and her staff currently work with several managed care providers. "We decide how to knit’ their programs together for a really full approach," she explains. "You never have everything under one roof."
Kinzer sees employer-based wellness professionals facing an additional challenge from health management organizations, which, at the very least, will require a different job description. "A lot of organizations have emerged that have a tremendous expertise in prevention, disease management, and outcome management that can be contracted by MCOs or employers companies such as StayWell, Summex, or Johnson & Johnson, call center organizations, and pharmacy benefits groups," he notes. "The in-house person is going to have to serve more as a broker, or a brand manager for the whole health promotion program positioning it within the corporation and managing the internal program. It will probably require a little greater marketing acumen and the ability to segment a population."
Professionals must know their business
Wellness professionals seeking employment with an MCO may have to go back to school, DeMarco adds. "This is a career path that, long-term, requires insurance knowledge as well as health promotion. The job description includes both identifying and helping the plan meet the needs of patients, as well as getting referrals," he says. "The really good health educators are being snapped up by the HMOs."
This new reality will also require an attitude adjustment among wellness professionals, says Reynolds. "The physiology of the human being and what drives behavior won’t change," he says. "But wellness professionals have to be ready to work with a less homogenous population such as HMOs work with seniors, all sorts of ethnic and economic backgrounds. What you’ll see is a bit of the old public health model, with which they need to become familiar. They may also need to be more cognizant of the medical model of integration, as they will likely be asked to solve a disease management problem by working with physicians. This requires a real first-hand understanding of how the medical world works."
De Marco cites a number of organizations that have already taken the "in-house" plunge and are pleased with the results. "Sears, for example, is self-funded," he notes. "They have meshed insurance with employee health and have found it to be much more effective.
"Huge organizations like Kaiser, Harvard University Group Health, even Nationwide Insurance see the value of having someone on staff to work with the HMO. It prevents unnecessary claims by reducing the need for unnecessary claims."
It’s ironic, says DeMarco, that we’ve gone full circle and ended up where we should have been in the first place. "We’ve tried everything else premium discounts, removing people from the group, and guess what works? Keeping people healthy! That’s what HMOs were duly created to do: put the patient first," he concludes.
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