Occupational medicine in a primary care world

The looming physician shortage, coupled with expanded health insurance coverage under the Affordable Care Act, an aging population and other pressures on the U.S. healthcare system are driving some occupational medicine providers to reposition themselves to take on primary care.

One prominent example of the shift to primary care comes from Concentra, a nationwide clinic chain that was acquired a year ago by Humana, a major medical insurer with more than 10 million members.

Back in 1979, Drs. Richard Rehm and Peter Fagan, then co-chairs of the Texas Tech Medical School Family Practice Residency Program, saw an opportunity and opened an occupational medicine clinic in Amarillo. Dr. Rehm explained: “It was a $100 billion segment of medicine that nobody paid attention to. I wanted to build a better mousetrap in this segment of healthcare that not only needed quality medicine, but also a more efficient business system applied to it.”

That single clinic led to the creation of a network, OccuSystems, which later became Concentra. In a March 23, 2010, CNN interview, Thomas Fogarty, M.D., chief medical officer of Concentra, articulated the company’s vision – not as a network of specialty occupational medicine clinics but as a “primary care-based healthcare organization.” At the time, he noted that with 315 clinics in 40 different states, Concentra was well-positioned to function as a “convenient, affordable access point for health care.”

About 3 million Humana subscribers reportedly live near a Concentra center. In addition, Humana can incorporate Concentra in its strategy for the development of an accountable care organization (ACO) under the ACA. This would allow it to share financial gains generated from improved clinical and economic performance, provided that quality goals and patient safeguards are met.

In a similar play, on July 2, 2012, Dignity Health, formerly known as Catholic Healthcare West, signed a definitive agreement to buy U.S. HealthWorks, which operates 172 clinics nationwide and contracts with 80,000 employers to control the costs of work-related injuries.

In a press release, Dignity Health explained: “The acquisition reflects the organization’s vision to become a national, integrated delivery network by 2020.”

Major Implications

By all accounts in the world of occupational medicine, the acquisitions by Humana and Dignity Health are a staggering development. While the free-standing clinic focused solely on occupational medicine is not dead by any means, there clearly is movement toward a return to the predominant, pre-1980 delivery model in which occupational medicine and primary care were combined.

Meanwhile, the impending physician shortage is poised to trump the argument that occupational medicine should be delivered separately. As the nature of the healthcare marketplace changes, so does the fate of occupational medicine.

We appear to be poised to undergo significant – and perhaps wrenching – change.

Visit the Tracker, our online journal, to read more about Repositioning Occupational Medicine in a Primary Care World.

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