Corporate Medicine Meeting New Challenges March 27, Clarion E. Johnson, M.D. Medical Director Medicine and Occupational Health-Global

Transcription

1 Corporate Medicine Meeting New Challenges March 27, 2008 Clarion E. Johnson, M.D. Medical Director Medicine and Occupational Health-Global

2 CORPORATE MEDICINE - MEETING NEW CHALLENGES

3 Overview of Presentation Brief Overview of ExxonMobil Examples of how Society of Behavioral Medicine interests are being applied in the private sector Overview of ExxonMobil Medicine and Occupational Health Core Services, Areas of Focus and the Occupational Health Centers of Excellence Partners in Health: ExxonMobil s comprehensive heath care strategy Malaria Control Program 3

4 Addressing the Needs of a Global Work Force We operate facilities or market products in nearly 200 countries and territories With 84,000 employees Upstream Exploration, Development, Production Downstream Fuels and Lubricant Refining and Marketing Chemical Manufacture and Marketing 4

5 In Diverse Work Settings 5

6 MEDICINE & OCCUPATIONAL HEALTH (MOH) Worldwide staffing: 460 including ~ 100 physicians on staff Operations around the globe: North America: Canada (Imperial Oil), Mexico, USA (10 cities) South America: Argentina, Brazil, Chile, Colombia Europe: Benelux, Eastern Russia (Moscow), France, Germany, Italy, Norway, UK Africa: Angola, Chad, Cameroon, Equatorial Guinea, Nigeria Middle East: Qatar Asia Pacific: Australia/Pac Islands, Indonesia, Japan, Malaysia, Singapore, Thailand, Western Russia (Sakhalin) 6

7 MEDICINE & OCCUPATIONAL HEALTH (MOH) GLOBAL CORE SERVICES Emergency response support Assessment and management of health risks Worker health protection programs (e.g. Hearing Conservation, Benzene, Asbestos) Fitness for Duty Injury/Illness Management - Prompt, adequate and appropriate - Communication with safety and line management Alcohol and Drug Use (ADU) policy support Travel health services including EMERS (Emergency Medical Response System) Operational Integrity Management System (OIMS) support Malaria prevention programs Oversight of field medical services (offshore platforms, pipelines, small facilities, terminals) 7

8 MEDICINE & OCCUPATIONAL HEALTH (MOH) GLOBAL AREAS OF FOCUS Globally, the types of services are quite similar to the U.S., but methods and settings may differ Some on-site services are provided (varies by country) Some primary care services are provided (varies by country) Some overlap between provision of primary care and occupational health services More remote oversight of MOH activities Challenging medical issues Challenging public health issues Infectious diseases Sanitation and potable water Availability of local medical services Evacuation of personnel with critical medical issues Language and cultural issues 8

9 MEDICINE & OCCUPATIONAL HEALTH (MOH) OCCUPATIONAL HEALTH CENTERS OF EXCELLENCE (COE) MISSION: To create value and preserve ExxonMobil s license to operate by protecting the health of our employees, business partners and customers through evidence-based, cost-effective occupational health services which meet applicable regulations, ExxonMobil policies and OIMS expectations. Pursuing Globalization / Harmonization Opportunities in the areas of: Injury / Illness Stewardship Global IH / OH Practices Exposure reduction for activities identified in the Exposure Assessment System (EAS) as higher risk Travel Medicine Occupational Evaluations Achieved through development of global common processes, tools & training, effective use of technology and cost-efficient delivery of clinical services. 9

10 MEDICINE & OCCUPATIONAL HEALTH (MOH) Address clinical service delivery issues Utilize global personnel with expertise/interest in specific areas Have ongoing responsibility for updating standardized forms & procedures Monitor new developments and trends Recommend evidence-based modifications Leveraging Our Diversity: Clinical Service Teams 10

11 PARTNERS IN HEALTH 11

12 HEALTH & PRODUCTIVITY So what are the costs of ill health and lost productivity? Source: U.S. Department of Health & Human Services;

13 HEALTH & PRODUCTIVITY Poor behavior is damaging U.S. population health status with significant cost consequences for employers 2004 U.S. health care spending totaled about $1.8 trillion (about 14% of GDP) Modifiable conditions impact health care costs, productivity, and mortality Obesity accounts for as much as 36 percent of cost increases Obese individuals are twice as likely to have high absenteeism Average diabetic misses 8.3 days per year vs. 1.7 days for people without diabetes Major Diseases and Chronic Conditions Are Key Cost Drivers Heart Disease & Stroke $300 Diabetes $132 Obesity $117 Asthma $14 $0 $50 $100 $150 $200 $250 $300 $350 Billions Per Year Source: U.S. Department of Health & Human Services;

14 HEALTH & PRODUCTIVITY COST IMPLICATIONS Neoplasms Circulatory Musculoskeletal system Digestive The Cost of Lost Productivity Fractures Genitourinary Nervous system Medical Disability Lost Productivity Infectious disease Normal pregnancy Mental disorder $0 $10 $20 $30 $40 $50 $60 Millions Per Year Source: IBI Research Insights, The Impact of Linking Medical and Disability Data, April

15 HEALTH & PRODUCTIVITY COST IMPLICATIONS Per Employee Direct Disability Costs by Industry Telecom $16,083 Retail $6,537 Mfging <10k Mfging>20k Insurance High Tech Mfging Health Care Services Financial Services $11,202 $12,021 $ $12,114 $8,839 $10,875 Energy $20,150 Banks $10,658 Auto Suppliers $12,211 $0 $15,000 $30,000 Dollars Per Employee Per Year Group Health Workers' Comp STD LTD Incidental Absence/PTO FMLA Source: Integrated Benefits Institute,

16 HEALTH & PRODUCTIVITY EVOLVING STRATEGY Many Employers Past, Present, Future Some Employers Present Many Employers Future (1-3 years) Few Employers Present Some Employers Future (3-5 years) Programmatic Benefit Management Integrated Benefit Management Integrated Health and Productivity Management Medical Behavioral Health Pharmacy LTD STD Incidental Absence Health Portal/ HRA Wellness and Prevention Care Management Occ Health and Safety Worker s Compensation Employee Health Management Integrated Disability Management (IDM) Integrated Health Management with Focus on Employee Presenteeism and Productivity Life, AD&D, Other Benefits Life, AD&D and Other Benefits 16

17 PARTNERS IN HEALTH Partners in Health, ExxonMobil s comprehensive health care strategy, was implemented for U.S. employees and pre-65 retirees in late 2003 GOAL: To provide U.S.-based employees with resources and programs that help them enjoy healthier and longer lives, leading to better managed health care costs. We attempt to reach this goal by helping EM employees and their dependents who are participants in the Medical Plan to : Stay healthy Become better users of health care by offering them tools and resources to help make good health care choices More easily access quality health care that s truly needed Avoid unnecessary health care costs 17

18 PARTNERS IN HEALTH Achieved primarily through specialized resources delivered through the health plan, supported by comprehensive participant communications Participant outreach, coordination of care and direction to Centers of Excellence by dedicated Health Advocate teams Disease and care management programs for cardiac, diabetes, musculoskeletal, and cancer Health information and risk awareness through customized health portal and annual health risk assessment 18

19 PARTNERS IN HEALTH Healthyroads Specifically trained health coaches help individuals lose weight and stop smoking ASH Health Portal Learn how to stay healthy, Get good information, Make informed choices Mayo Clinic Health Advocate/ 24 RN Line Highly-trained nurses ensure individual gets care needed Aetna and CIGNA Life Assistance Resources Counseling Magellan Health Risk Assessment Assess your health status, learn hot to maintain health, address health risks before disease develops. Mayo Clinic Partners in Health Cancer Management Specifically trained cancer management nurses help manage the clinical oncology experience Matria Disease Management Highly-trained nurses help participants manage conditions where lifestyle choices influence outcomes Matria, Aetna, CIGNA, Medco Centers of Excellence Nationally-recognized facilities offer expertise to deliver superior outcomes for serious conditions Aetna and CIGNA 19

20 PARTNERS IN HEALTH Program 24 Hour Nurse Line Health Advocates Disease Management Centers of Excellence Cancer Care Management Wellness Health Risk Assessment Description Trained nurses provide answers to emergent health questions any time of day or night; make referrals to Health Advocates. Highly experienced, licensed, registered nurses, specifically trained to work with individuals one-on-one and help them navigate through the health care system and make informed choices. For certain diseases, especially those where changing lifestyle habits can have a positive impact, a Disease Management nurse can provide ongoing education and guidance. For specific conditions requiring high-level knowledge, experience and expertise that is critical to a positive outcome, individuals and their care givers may be referred to a facility in another part of the country that is recognized for excellence in that specific medical area. Special care for individuals in active cancer treatment to manage the medical and emotional side effects of living with and surviving cancer. Programs in the areas of Obesity Management and Smoking Cessation will be introduced in 2008 Tool to assist employees assess health status, learn how to maintain health and address health risks before disease develops. 20

21 PARTNERS IN HEALTH HEALTH PORTAL Customized website and Health Risk Appraisal Internet gateway to a world of reliable health care information 21

22 Behavioral Health Program Some last words Supporting all our other health and productivity improvement efforts: Behavioral Health Program Source: U.S. Department of Health & Human Services;

23 Behavioral Health Program According to the Employee Assistance Professional Association of America, a well-run Employee Assistance Program (EAP) can reap an employer the following savings: 33% percent less use of sick leave benefits 65% lowered incident of workplace accidents 30 % deduction in worker s compensation claims 35% decrease in health insurance expenditures The US Department of Labor has shown that for every dollar invested in an EAP, the employer saves five to sixteen dollars. 23

24 PARTNERS IN HEALTH BEHAVIORAL HEALTH Confidential, counseling services that help individuals and their eligible family members work through challenges of life. Counseling Work-Life issues Financial Issues Legal Issues Emotional aspects of other health problems 24

25 Behavioral Health Program ExxonMobil Employee Health Advisory Program includes: Telephonic Consultations (24/7) and Crisis Support Face to Face Counseling Sessions--short term problem resolution & referrals Management Consultation Support Services (Supervisory Referrals) Employee and Supervisory Worksite Trainings Critical Incident Stress Debriefing Sessions Program promotion (push s, posters, wallet cards, website, health fairs) Legal and Financial Services Dependent Care Resources and Referrals (child to elder care) 25

26 Behavioral Health Program Managed Mental Health Program Cross referrals between medical vendor and MH vendor Co-manage cases with medical vendor with medical and mental health diagnosis (example heart disease with depression) Intensive mental health case management with acute, chronic and complex conditions (frequent contact up to 1 year with patient and family) According to the National Institute of Mental Health, an estimated 17 million Americans experience serious depression each year. Patients with depression utilize significantly more health care services, leading to health care costs that can be twice as much as for those without depression. Annual costs for lost productivity and absenteeism exceed $3,000 per employee with depression. 26

27 Behavioral Health Program AfterCare Program Structured relapse prevention counseling for employees in recovery from chemical dependency addiction for 2 year duration Company support through supervisor, MOHD and union representation Random drug testing for all cases and Supervisory addiction training Alcohol and drug abuse has been estimated to cost American business roughly 81 billion dollars in lost productivity in just one year - $37 billion due to premature death and $44 billion due to illness. Of these combined costs, 86 percent are attributed to drinking. 27

28 Malaria Control Program 28

29 Malaria Control Program BACKGROUND As personnel numbers increased in sub-sahara Africa, we needed a Malaria Control Program (MCP) In 2001, EM developed and implemented a comprehensive MCP based on A-B-C-D strategy: A = Awareness B = Bite Prevention C = Chemoprophylaxis for non-immunes D = Diagnosis early & treatment GOALS Zero malaria cases in non-immunes Zero serious malaria cases/deaths in semi-immunes 29

30 Adding Management Controls to Malaria Control Program Despite intensive training efforts and the provision of effective antimalarial medications as well as bite prevention supplies and vector control efforts, four malaria deaths occurred in Contractors providing services to EM MALARIA CHEMOPROPHYLAXIS COMPLIANCE PROGRAM (MCCP) Developed to address issues of non-compliance with chemoprophylaxis Random urine testing program that seeks to verify the use of effective malaria chemoprophylaxis by non-immune personnel in areas where required by EM Required for all EM employees AND all contractors performing services for EM in malarious areas MALARIA VISA Standard online training program using videos and content questions, repeated annually, to ensure all personnel understand how to protect themselves from contracting potentially fatal falciparum malaria Non-immunes sign Attestation Forms agreeing to random testing to verify compliance with anti-malarial medication requirements 30

31 Malaria Control Program Bite Prevention & Vector Control MALARIA CONTROL OFFICERS MANAGE PROGRAM IMPLEMENTATION AND STEWARDSHIP PERSONAL PROTECTION Mosquito bite prevention with insecticide (DEET), permethrin treatment of clothing, insecticide-treated bednets Vector control utilizing basic public health measures, including use of indoor residual spraying, reduction of standing water, etc. EARLY DIAGNOSIS AND TREATMENT Needs to be addressed in malarial areas with little remote access or limited access to quality health care Needs to be addressed in developed countries (US and Europe) where health care providers are unfamiliar with diagnosing malaria and not equipped to provide rapid and effective treatment 31

32 Summary of Presentation Brief Overview of ExxonMobil Examples of how Society of Behavioral Medicine interests are being applied in the private sector Overview of ExxonMobil Medicine and Occupational Health Core Services, Areas of Focus and the Occupational Health Centers of Excellence Partners in Health: ExxonMobil s comprehensive heath care strategy Malaria Control Program 32

33 Questions? Questions? 33

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