Oh so simple

Employers are becoming increasingly open to occupational health solutions. Sam Barrett finds the subject becoming something advisers must know more about

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Once there was a time when occupational health (OH) was only seen in the public sector and other large organisations or those using hazardous materials or carrying out dangerous activities. But, with increases in legislation and employers keen to keep their workforces healthy and productive, it’s become a much more common feature of a corporate healthcare strategy.

“Most of our clients have some form of OH now,” says Richard Chandler, client director at Enrich. “We work with them to understand how it can benefit their business. For some it’s a matter of covering off the mandatory requirements; others want to use it for broader benefits such as employee engagement and improving productivity.”

Reflecting this growth in demand, OH services have become more readily available. As well as offering the traditional onsite services, most also provide remote services to support the needs of more organisations. As an example Chandler says he has seen more take-up for remote OH case management services. “This can work well,” he says. “Access is easy and the service is fast. It can offer good value, especially for smaller companies that want this type of service less frequently.”

In addition to the services offered by the standalone providers, many of the insurers are now linking up with OH services to enhance their product offerings. On medical insurance, this has been largely through health and wellbeing initiatives while the group risk providers have focused more on adding in employee assistance programmes and rehabilitation programmes. “This has helped raise awareness of OH services and brought more advisers into the arena,” says Dave Priestley, director of sales at PruHealth. “Talking to clients about OH can benefit an adviser’s business by helping to cement the relationship.”

Not everyone is a fan of this freebie approach though. Chris Ford, director of group risk for Jelf Employee Benefits, says that it can lead to patchy results. “The insurers’ main drive with these add-ons is to control the rising cost of claims so they’re only interested in the insured population. If you don’t cover all employees you could have problems when an uninsured person needs the service,” he explains.

But, love the add-ons or hate them, they’ve certainly helped to make it much easier to access OH services, while at the same time fuelling demand from employers for advice on this area.

For those employers wishing to incorporate OH into their healthcare strategy, advisers must be prepared to take on much more of a consultancy role. Ford says that rather than speaking to the people responsible for the benefits package, you should involve all the relevant parties within an organisation to fully understand what they’re trying to achieve. “For some clients we’ve got together representatives from benefits, HR, finance and OH to discuss how we can improve the existing services or introduce new ones,” he explains. “You do need to take control once you step away from the pure broking model.”

As part of this, he suggests undertaking a full benefits audit. This helps to show where there are any crossovers in product provision but also enables recommendations to be aligned with the client needs. Additionally, it can often be necessary for the adviser to provide HR advice. Chandler says it’s important to understand an organisation’s HR strategy when recommending OH services. “We’ll always look at the HR policy and see whether this complements the services we’ve recommended. We might see a policy that says OH only gets involved when someone has been absent for 14 days. But this is a long time so we’d question why they don’t get involved earlier,” he explains.

Another key part of the adviser’s service can be to ensure all the healthcare products, whether OH or insurance, are integrated properly to improve their effectiveness. Chandler explains: “An absence management system could get in early and direct a sick employee to the medical insurance or for physiotherapy. This potentially reduces the severity of the problem and gets them back to work quicker.”

This isn’t always as straightforward as it seems. Rules regarding data protection mean that clients must understand the protocols that need to be in place when referring an employee from one service to another. Having an adviser in place with a good understanding of what’s required can make a significant difference to the success of product integration.

But although demand is on the up, this isn’t always the case. Mike Blake, compliance director at PMI Health Group, says: “We are seeing more demand for OH services but not every client is interested. Some simply want the best price and only want us to carry out a broking exercise.”

However he expects this to change. “Employee wellness is an area that more employers will be looking at. They’ve cut just about every other cost in the business: absence is the last area where they could make improvements,” he explains. “Further, while the government is talking about doing away with a decade of health and safety rules, you can be sure there’s never going to be less legislation.”

A greater demand for OH from employers will also require change from advisers. Although there has been a shift towards offering consultancy services, some advisers still operate a more product driven broking model. “At the moment there’s still room for this but it’s becoming less of an option. In the large corporate market there’s an expectation that the healthcare adviser will have an understanding of OH. It does take time and effort to gain this but it can be worth it,” he says.

Raising the bar in this way will bring benefits. Priestley points to the current battle for business that is engulfing the healthcare market as evidence. “I’ve seen schemes with an annual premium of just £10,000 to £15,000 where 10 intermediaries are involved. Unless the organisation is only looking at price, you can be sure that the business will go to those intermediaries that talked about how they could use OH and other benefits to improve performance. It’s like everything else; if you don’t innovate you become commoditised and then there’s no need for advice.”

Becoming a provider of oh services

For the PMI Health Group, rather than recommend other occupational health services, it decided to bring this function in-house in 1992. “Clients wanted it,” explains the company’s compliance director, Mike Blake. “We had been recommending external suppliers but by bringing it in-house we were able to have control over the delivery.”

The service is small in comparison to some of the large OH providers, with two doctors and eight nurses employed by PMI Health Group. “We can provide onsite services to local clients but it’s also possible to undertake a lot of the work remotely. For instance, this works well for ill-health referrals where an employer wants us to review a doctor’s notes,” says Blake.

This ad hoc, pay as you go, service works particularly well for smaller clients in the private sector where there’s no need to have a full-time OH service. For larger clients, or those based in other parts of the country, capacity can be increased through relationships with a nationwide network of OH specialists.

“It is beneficial to be able to offer clients this service and it fits with our strategy to be an employee healthcare business,” says Blake. “But it isn’t the right approach for every adviser. It’s expensive to employ OH specialists so you need to have sufficient business to cover their costs. OH will become more commonplace but you need to consider whether providing your own OH services is the strategy you want to adopt.”

Need to know – ADVISERS

Occupational health is a broad topic, covering everything from health and safety legislation to employee wellbeing. “It’s about the effects of health on work and work on health,” explains Dr Jenny Leeser, accredited specialist in occupational medicine at Bupa. “This includes employment law and health and safety legislation as well as an appreciation of the nature of the diseases and conditions that can affect employees.”

Having an in-depth understanding of all these areas isn’t necessary as an adviser but, for anyone wishing to offer OH advice Dr Leeser says it’s important to understand what’s available and how it can be used in the workplace. “To be able to give meaningful advice, you need to understand the health profile of the organisation and the OH interventions it could use. It’s no good selling a Rolls Royce service if all they want is a Mini,” she explains.

To make it easier to digest, she divides OH into three areas: pre-employment, which covers pre-employment questionnaires and screening; health at work, which includes health promotion, statutory medicals and surveillance; and absence management, which includes rehabilitation, ill health retirement and return to work.

“I don’t expect advisers to have a really in-depth understanding of OH,” she adds. “I liken OH to a toolbox. As long as the adviser knows what’s in the toolbox and when it can be used then the providers will bring the expertise.”