Role and Value of the Corporate Medical Director.

ABSTRACT: The role of the Corporate Medical Director (CMD) has received increased attention during the COVID-19 pandemic and has continued to evolve. This updated guidance addresses the role and value of the CMD in: health policy, strategy, and leadership; fostering a culture of health and well-being; supporting worker health and productivity/performance; addressing mental health; collaborating on employer benefits design; developing programs for global health, travel medicine, and remote/extreme environments; overseeing on- and near-site clinics; incorporating digital technology, artificial intelligence, and telehealth in health programs; supporting critical incident preparedness and business continuity planning; addressing workplace hazards; and overseeing periodic executive health examinations.

Worksite Temperature Screening for COVID-19.

OBJECTIVE: To determine whether temperature screening is useful in detecting and reducing workplace transmission of SARS-CoV-2. METHODS: A survey was conducted to determine whether temperature screening successfully identified workers with coronavirus disease 2019 (COVID-19) among a convenience sample of medical directors of multinational corporations in a wide range of industries. RESULTS: More than 15 million screenings were performed by 14 companies. Fewer than 700 episodes of fever were identified. Of these, only about 53 cases of COVID-19 were detected. By contrast about 2000 workers with diagnosed COVID-19 were in the workplace and not detected by screening. CONCLUSIONS: One case of COVID-19 was identified by screening for approximately every 40 cases that were missed. Worksite temperature screening was ineffective for detecting workers with COVID-19 and is not recommended.

Role and Value of the Corporate Medical Director.

: The role of the corporate medical director (CMD) has evolved over the last 300 years since Ramazzini first identified diseases of Italian workers in the early 1700s. Since then, there has been a gradual blurring of the boundaries between private and workplace health concerns. Today's CMD must have intimate knowledge of their corporation's industry and the businesses that they support, particularly the occupational and environmental programs that comply with all local, state, and/or national standards and regulations. Leading companies not only measure compliance with such standards but also may hold programs to their own internal corporate global standards even if these go beyond local government requirements. This document will explore in greater depth the strength and importance that the CMD brings to the business operations to support a healthy, engaged, and high performing workforce. Part 1 describes the role and value of the CMD, while Part 2 provides collective wisdom for the new CMD from current and past highly experienced CMDs.

Integrating health and safety in the workplace: how closely aligning health and safety strategies can yield measurable benefits.

OBJECTIVE: To better understand how integrating health and safety strategies in the workplace has evolved and establish a replicable, scalable framework for advancing the concept with a system of health and safety metrics, modeled after the Dow Jones Sustainability Index. METHODS: Seven leading national and international programs aimed at creating a culture of health and safety in the workplace were compared and contrasted. RESULTS: A list of forty variables was selected, making it clear there is a wide variety of approaches to integration of health and safety in the workplace. CONCLUSION: Depending on how well developed the culture of health and safety is within a company, there are unique routes to operationalize and institutionalize the integration of health and safety strategies to achieve measurable benefits to enhance the overall health and well-being of workers, their families, and the community.

Medical evacuations from oil rigs off the Gulf Coast of the United States from 2008 to 2012: reasons and cost implications.

OBJECTIVE: To identify reasons for air medical evacuations from oil rigs/platforms. METHODS: Retrospective review of data of medical calls from 102 rigs/platforms in the US Gulf Coast from 2008 through 2012 with specific analysis of medevacs. RESULTS: On average, 1609 total calls per year relating to illness or injury on the 102 oil rigs/platforms with 4% to 7% requiring medical air evacuation. On average, 77% of medevacs were for nonoccupational medical injury or illness. CONCLUSIONS: Illness, not occupational injuries, is identified as the major reason for medical evacuations from oil rigs. Heart disease is the leading cause of chronic health conditions resulting in a medevac.

Shifting the focus from cost to value: an employer perspective.

OBJECTIVE: To review ways in which pharmacists can help health plans shift their focus from cost to value. SUMMARY: Health care delivery is a continuum. Employers have moved along the continuum looking for value; they are now looking for integrated strategies to decrease cost and improve productivity within the workforce. The key to any integrated strategy is innovative service delivery and ground-breaking partnerships with vendors. Key areas that need to be addressed are medical care, pharmacy, behavioral health, disability, prevention, and presenteeism. Additionally, measuring program effectiveness is becoming more important, especially in terms of continuous improvement. CONCLUSION: Updating data, fine-tuning plan design to improve effectiveness, and abandoning ineffective efforts is critical. The ultimate goal is to modify the target population.s risk.

Factors affecting the frequency of value-focused health activities and policies by employers.

OBJECTIVE: We sought to gather employer perspectives about value-focused activities (VFAs), intentions to make decisions based on value, and other factors affecting decisions. METHODS: Health decision-makers (n = 174), both American College of Occupational and Environmental Medicine members and corporate HR/benefits directors, responded to an Internet-based questionnaire. RESULTS: Of a total of 32 listed VFAs, companies reported, on average, performing 5.2 activities currently and considering 2.6. Twenty-five percent of companies reported doing eight or more. The most common VFAs were providing access to flu shots, centers of excellence, and wellness programs. Greater access to detailed outcome data was associated with doing more VFAs, as was greater accountability for absence, disability, and productivity outcomes. CONCLUSIONS: Employers vary widely in the number of VFAs in which they participate. Decision-makers with more information about, and accountability for, value outcomes reported doing more VFAs.

Using the World Health Organization Health and Work Performance Questionnaire (HPQ) to evaluate the indirect workplace costs of illness.

This report presents an overview of methodological issues in estimating the indirect workplace costs of illness from data obtained in employee surveys using the World Health Organization Health and Work Performance Questionnaire (HPQ). The HPQ is a brief self-report questionnaire that obtains three types of information: screening information about the prevalence and treatment of commonly occurring health problems; information about three types of workplace consequences (sickness absence, presenteeism, and critical incidents); and basic demographic information. The report considers two sets of methodological issues. The first set deals with measurement. The rationale for the HPQ approach to measurement is described in this section. In addition, data are presented regarding the accuracy of HPQ measures, documenting that the HPQ has excellent reliability, validity, and sensitivity to change. The second set of methodological issues deals with data analysis. A number of analysis problems are reviewed that arise in using self-report nonexperimental survey data to estimate the workplace costs of illness and the cost-effectiveness of treatment. Innovative data analysis strategies are described to address these problems.

Health-related workplace productivity measurement: general and migraine-specific recommendations from the ACOEM Expert Panel.

An establishment of health-related productivity measurements and critical evaluation of health-related productivity tools is needed. An expert panel was created. A literature search was conducted to identify health-related productivity measurement tools. Each instrument was reviewed for: 1) supporting scientific evidence (e.g., reliability and validity); 2) applicability to various types of occupations, diseases, and level of severity of disease; 3) ability to translate data into a monetary unit; and 4) practicality. A modified Delphi technique was used to build consensus. The expert panel recommended absenteeism, presenteeism, and employee turnover/replacement costs as key elements of workplace health-related productivity measurement. The panel also recommended that productivity instruments should: 1) have supporting scientific evidence, 2) be applicable to the particular work setting, 3) be supportive of effective business decision-making, and 4) be practical. Six productivity measurement tools were reviewed. The panel recommended necessary elements of workplace health-related productivity measurement, key characteristics for evaluating instruments, and tools for measuring work loss. Continued research, validation, and on-going evaluation of health-related productivity instruments are needed.