You may add to the many "silo problems" facing those who wish to use health data to its full potential the fragmentation of health and safety data in the typical American workplace. Yet, the two are interdependent and some of the nation's most prominent experts in occupational medicine say it is time to begin coordinating and quantifying the effort to improve the nation's health at work.

"Safety and health interact, and we know that people who have injuries at work tend to have more of them and more severe ones when they are unhealthy, and that unsafe workplaces tend to have more people who are unhealthy," said Robert McLellan, M.D., medical director of occupational and environmental medicine at Dartmouth-Hitchcock Medical Center in Lebanon, N.H..  "Over the past few years, there has been an increasing recognition of this interaction."

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McLellan is a co-author of a paper published in the May 2015 issue of the Journal of Occupational and Environmental Medicine by the American College of Occupational and Environmental Medicine and Underwriters Laboratories. The paper, for the first time, lays out an integrated health and safety model, featuring an index based on the methodology of the widely used Dow Jones Sustainability Index. The proposed index would translate the impact of employer health and safety programs into business value for the investment community, measuring the effectiveness of employers' health and safety programming using the Dow's familiar categories of economic, social, and environmental sustainability.

"At the societal level, the impact of this new way of approaching workplace health and safety is profound," McLellan and his colleagues wrote. "As the United States and the rest of the world face the rising burden of costs associated with chronic disease and poor health, numerous studies suggest that comprehensiveintervention strategies will be required. Evidence confirms that standalone, non-integrated efforts to address these issues will not succeed."

Until now, healthcare systems have not been particularly engaged in creating any sort of integrated method around the health/safety continuum; the existence of so many organizational and data silos separating statistics and actions around workers' compensation data, Occupational Safety and Health Administration data, group health claims data, disability data, and absenteeism data is one big reason, according to McLellan.

McLellan also predicted that initial forays by healthcare organizations into this model will not come as providers, but rather as employers "who are beginning to get the message that in a big way, just like all employers, they have tools and leverage and the business imperative to impact the health of their own workforce."

In terms of metrics, at least initially, McLellan said detailed EHR-based analytics are not likely to be keystone data elements—most employers, especially those outside healthcare, are more likely to get their employees' personal data out of claims data, health risk assessments, and biometric data.

This data will be essential in quantifying the link between employee health and productivity, according to the group's blueprint. Population health management, they said, will have to be incorporated as an important component in an adopting organization’s business strategy, and the total economic impact of health, including direct medical and pharmacy costs of healthcare as well as indirect productivity-related costs, such as absenteeism rates, will have to be measured, reported, and acted upon.

McLellan said the timing to advance the index concept is propitious as the prevailing health payment models shift to value-based care and employers, providers, and community partners begin to align activities to improve population health. In fact, he said, healthcare systems in smaller communities may actually be in the vanguard in realizing the benefits of the integrated approach, as they are often such communities' largest employers.

"Employers cannot be successful in improving the health of their workplace unless they also invest in community health, and this is most obvious in situations where the healthcare system is the largest employer in town, because the community is us," he said. "When you think about where are we hiring our workforce from, it's the community, and if the community is unhealthy, we are bringing unhealthy people into our workforce.

"This is a natural trajectory. How quickly it moves, we'll see. But we know the escalation in the cost of poor health to society and employers is rapid. Everyone is saying it is unsustainable, so unless employers and healthcare providers catch on to this, we're in trouble."

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