NEWS FROM

Health NavigationFinding a Path to Better Health and Lower Costsby Curtis H. Smith Executive Vice President

If you or a loved one has ever been hurt or sick, you know well that healthcare and insurance systems are compli-cated; the challenges can seem endless and overwhelming.

Health navigation helps individuals and companies through these challenges. Medcor’s health navigation includes clinical services, of course, but it’s much more than that. Knowing what services are needed, where to get them, and in what timeframe are critical elements to getting on the right path to recovery.

People can’t always tell at the onset how serious an injury or illness is. So, sometimes they go to an ER when they could have gone to a doctor’s office, or they go to a doctor’s office when they could have cared for themselves. Other

times people underestimate or don’t recognize symptoms, and look back wishing they had realized how serious something really was – this regret can make them more likely to overreact the next time they are confronted with a health concern.

The fundamental premise of health nav-igation is getting people the care they need when and where they need it, which removes burdensome guesswork. Med-cor’s clinicians navigate people to the right level of care at the right time, in the right place. Medcor’s systems help peo-ple determine the severity of each case and the best course of action for treat-ment. When we can provide the needed care or guide patients in self-care, we do. When further care is required, we make referrals.

People know overtreatments and over-prescribing exist, but they don’t know how to tell when it is happening to them. What’s the best practice?

Evidence-based medicine is the best practice; it represents the science of proven medical effectiveness. Medcor’s protocols, algorithms, and guidelines are built on evidence-based medicine. As a result, we help avoid unneces-sary treatments and prescriptions while required treatments are obtained right away.

People want to believe that all providers follow best practices, but still unneces-sary care persists, including surgeries,

SUMMER 2018

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Health Navigation P1

OSHA’s New Silica Standard P2

Recruiting for a Remote Workforce P3

Strategies for Better Sleep P5

IN THIS ISSUE

Copyright © 2018 Medcor, Inc. All Rights Reserved.

FEATURED ARTICLE

Summers at Yellowstone National Park DIY First Aid Kit with Tips from Our Experts! P4

prescriptions, therapy, and other inter-ventions that contribute to high costs for everyone.

The healthcare and insurance systems have evolved to include many con-flicts of interest, financial biases, and administrative costs. Effective navi-gation requires guiding patients to the right destination rather than follow-ing the momentum and pressures of a complex claims-driven system. Medcor operates transparently and without con-flicts of interest. This is a key difference between treating patients and advocat-ing for them.

It can take weeks to get an appointment. Lack of access to care drives frustration and drives people to go to more expen-sive options such as urgent care centers and ERs.

Medcor’s clinics are convenient and accessible. Mobile units go to patients. Our virtual health services are avail-able on-demand 24/7. Our clinic staff know the in-network providers in their communities, establish relationships, and have the tools necessary to gain appointments. Our triage service is pre-loaded with clinics that accept walk-ins and new patients.

Serious illness and injury involves a lot of emotion, which affects people’s deci-sion making. It feels awkward to tell a provider you want a second opinion or other options. It is not easy to know if a provider is in-network or out-of-net-work, and it is near impossible to find out in advance what services cost.

Navigation requires decision support – not just information, but recommen-

dations. People need reassuring, they want to know the risks, and they appre-ciate assistance.

Health navigation gets people through the system to achieve better clinical out-comes and lower costs. That’s good for individuals, and it’s also good for their employers, who bear much of the cost of caring for their employees and their families, and who want their employees to be healthy and productive.

About 2.3 million Americans are exposed to silica dust at work, accord-ing to the Occupational Health and Safety Administration (OSHA). Silica is a naturally occurring mineral that makes up nearly 60% of Earth’s crust. Worker activities such as cutting or drilling concrete, grinding stone, performing abrasive blasting, making concrete, glass, clay, or porcelain products, for a few examples, can generate fine parti-cles of crystalline silica that become trapped in the lungs when inhaled.

Respirable crystalline silica in the lungs may not show any adverse effects for

decades, but eventually it can cause devastating health problems such as the lung disease silicosis (leading to respiratory failure), lung cancer, chronic obstructive pulmonary disease (COPD), and kidney disease.

In 2016, OSHA published new silica standards, establishing a lower per-missible exposure limit (PEL) than what had previously been established in the 1970s. When the new standards are completely adopted, OSHA estimates that 700 lives will be saved and 1,600 cases of silicosis will be prevented annually.

Most of the silica standard provisions for the construction industry began being enforced last fall. Construction entities that are not able to comply with OSHA’s construction silica exposure control methods (outlined in “Table 1”), must adhere to alternative exposure control methods; these alternative methods are

also used by general industry. This sum-mer, on June 23rd, most silica standard provisions for general industry and mar-itime began to be enforced. Sectors that must adopt the new silica standard this summer include dental laboratories, manufacturers of asphalt roofing materials, concrete, glass, clay, or porcelain products, foundries, stone cutters, railroads, shipyards, and jew-elry and pottery makers.

The OSHA standard for general indus-try and maritime (29 CFR 1910.1053) requires several key things from employers. First, they have to determine if workers are at risk of being exposed to an action level of 25 μg/m3 silica dust averaged over an 8-hour day (μg/m3 = micrograms of silica per cubic meter of air) and then implement methods to pro-tect workers from being exposed above

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Breathing Better with OSHA’s New Silica StandardEffective for General Industry and Maritime this Summerby Raymond Loch Safety Training Manager, and Jason Funk, Safety Training Coordinator

Medcor’s clinicians navigate people to the right level of care at the right time, in the right place.

Bad combination: no machine guard, no gloves, and a big cloud of silica dust.

NEWS FROM MEDCOR | SUMMER 2018 P2

Talent acquisition is no simple task. Many considerations go into finding and hiring the right candidate for a position. Because the majority of Medcor advo-cates work remotely, away from the corporate office, Medcor’s talent acqui-sition team has developed some best practices for finding the best fit. Medcor remote advocates may work from home (for example, as triage nurses), while others work onsite at the client’s place of business (for example, as clinicians in a worksite clinic). Here are some of the ways we overcome the challenges of recruiting for a remote workforce:

CommunicationWhether someone is working from home or in a clinic, by themselves or in a small team, communication is key to long-term success with a company. When gauging someone’s communica-tion skills, we look for people who are outgoing, engaging, proactive, and not afraid to ask questions.

Previous experienceWhen evaluating candidates for roles that require independent work, previous experience working alone or in a remote setting is a plus. It is harder for a person to transition to an independent role if a team environment is where they usually thrive. Asking scenario-based ques-tions helps to understand someone’s aptitude for working in these types of roles.

Self-motivationWhen interviewing candidates to deter-mine their level of self-motivation, we ask questions like “Have you ever taken on a role that is outside of your normal job duties?” or “What do you like to do to stay busy?” We look for people who can work with basic instructions. Are they the type of person who is constantly asking their managers for guidance, or are they taking the lead on getting things done?

Culture fitWhile it is important for us to hire advo-cates who fit in well with Medcor’s culture, in work settings such as our worksite clinics, it is equally important that they have a cultural fit with the client. Many times, there is an over-lap between Medcor’s culture and the client’s, but sometimes there are differences. Communicating these dif-ferences up front allows us to make sure that we are hiring the right person for the client’s clinic.

Understanding the roleThis is one of the most important items to convey to a potential advocate. We want people to take a position fully understanding the responsibilities of the job and knowing what to expect. For an onsite role, the expectations need to be set that they are employed by Medcor, but most of their interactions will be with the client. They must differentiate working for Medcor and working with the client. For the work-at-home role, expectations are set early in the inter-view process, and those expectations are reiterated throughout the entire interview process. By the time some-one is ready to start with Medcor, they should have a clear understanding of the position and what their job entails.

We’ve found that if each one of these points is fully executed and under-stood in the interview process, then that increases the likelihood of hiring advo-cates who fit the position and love their jobs.

Recruiting for a Remote Workforce An Insider’s Perspective on Finding the Candidate who Fits Bestby Erik Gottlieb Director of Talent Acquisition

Silica continued from p2

the new PEL of 50 μg/m3 averaged over an 8-hour day.

Additionally, they must have a written exposure control plan. They also must offer chest X-rays and lung function tests every three years to workers who are exposed at certain levels. Record-keeping of exams and exposures are required, and silica dust safety training for workers is mandatory.

In terms of exposure control, the gen-eral industry silica standard calls for regulated areas in the work space that are clearly-marked zones with limited accessibility where exposure may be in excess of the PEL. Other exposure control methods include “wet meth-ods” (using water during processes where dust is made to limit the amount in the air), exhaust ventilation, enclo-sures to trap and isolate the dust as it is being made, and good house-keeping methods (no dry sweeping, only wet sweeping or HEPA vacuum-ing). Respiratory protection must be available for situations where other exposure control methods are limited.

A few of the greatest challenges that general industry faces is the cost of the transition (the installation of ventilation, for example, or the fees associated with testing silica dust levels); adapting their workforces to wearing respirators (in compliance with respiratory protection standard 29 CFR 1910.134); and environmental issues – silica is a major component in 95% of rocks – trying to limit exposure to something so widespread will likely present difficulties.

This article is intended as a summary only. For greater detail about the standard and its requirements, visit: www.osha.gov/silica.

NEWS FROM MEDCOR | SUMMER 2018 P3

Summer season is also tourist season. A popular summer U.S. travel destination is Yellowstone National Park. For the adventuresome, the more than two million acre wilderness boasts breathtaking mountains and waterfalls, famous geysers, and hundreds of species of wildlife in their natural habitat, from bison to bears. Yellowstone sees approxi-mately four million visitors annually, about half of whom come during the summer months of June, July, and August. Additionally, around 775 park employees and 3,200 concessioners – both mostly seasonal – are there to take care of the park.

Given the large numbers of people, it is no surprise that inevita-bly some of them will require health services while they are there. Depending on one’s location within the park, hospital care by ground transportation is one to three hours away. Fortunately, there are three clinics inside Yellowstone, and Medcor is celebrating its sixteenth summer as their operator, providing medical care to thousands of vis-itors, park employees, and concessioners.

Two of the clinics, named Lake and Old Faithful after their locations within the park, are open mid-May through September to accommo-date the influx of tourists, and the Mammoth clinic is open year round. All of them are equipped to handle medical and trauma emergencies as well as provide stabilization for transportation. In such a remote, rugged wilderness setting, these capacities are needed on occasion.

In addition to wilderness medicine, these clinics encounter diverse kinds of medical situations from mosquito bites to motor vehicle acci-dents to myocardial infarctions (heart attacks). The clinics commonly see sprains and strains but troubles like urinary tract infections, short-ness of breath, and fractures are also frequent.

Medcor clinic staff return to Yellowstone summer after summer. What keeps them coming back? Top reasons include the special sense of community there, the friendships of a lifetime that have developed among staff, and the staff’s love for seeing patients from all over the world. One Medcor provider at Yellowstone, John Bradford, PA-C, said: “It is fulfilling to take care of patients with all levels of acuity in a more personal and comprehensive manner than a traditional emer-gency department.” Other reasons for returning? The recreational opportunities, of course! Yellowstone has plenty to offer in the way of sightseeing, hiking, camping, backpacking, kayaking, rafting, fishing, and more.

Stay safe this summer! And if Yellowstone is among your travel desti-nations, stop by and say hi.

Summers with Medcor at Yellowstone National Park by Deborah Brown, RN Director of Operations for Medcor at Yellowstone

Build Your Own First-Aid Kit!

NEWS FROM MEDCOR | SUMMER 2018 P4

Use these recommendations from Medcor's medical experts at Yellowstone National Park to make your own first-aid kit.

It is prudent to always have a first aid kit with you, especially when traveling, hiking, fishing, backpacking, and camping. The contents of your first aid kit will depend on many factors, including the length of your trip, the number of people with you, your medical expertise, and where you will be. While you need to be prepared, it is also not practical to carry supplies for every possible situation. Overly bulky kits are often left behind. Consider what you may need; consult with your own physician for advice if you have a medical condition.

Essential items include:• Identification; pencil and note pad• Hat, sunglasses, and bandana• Topographic map and compass• Pocket knife or combi-tool; nylon cord• Whistle and small reflective mirror• Lighter or waterproof matches• Poncho and space blanket• Water purification kit (filter or chemical or UV)• Sunscreen (preferably sweat/waterproof and at

least SPF 30)• Lip balm (with SPF)• Nonperishable high-carbohydrate energy bars• Survival guide/first aid booklet• Adhesive compress and tape/blister remedies• Adhesive bandages (e.g., Band Aids®) and

sterile gauze• Personal prescription medications, labeled (in

plastic/waterproof box)• Over-the-counter medications (if no allergy or

contraindication—discuss with your personal physician)

- Acetaminophen (e.g., Tylenol®) - Naproxyn (e.g., Aleve®) - Diphenhydramine (e.g., Benadryl®) - Decongestants for cold symptoms - Heartburn relief - Anti-diarrheal - Antibacterial/antiseptic ointment

Whenever you do activities in a remote location, be sure to let someone know where you are going, when you are leaving, and when you plan to come back. Call 911 for any emergency situation, but be sure to bring a map and compass with you. Remote areas do not always have reliable cell or GPS coverage.

Getting sustaining and plentiful sleep is among the wellness lifestyle practices that Medcor identifies as guiding health principles. According to a recent poll by the National Sleep Foundation, 65% of Americans say they are more effective when they get enough sleep. If sleep is key to helping us be more effective, shouldn’t we put effort into making sure we get enough quality sleep?

There are many actions you can take to improve both your sleep quantity and quality. Your bedroom environment is a great place to start. Researchers and experts from the Division of Sleep Med-icine at Harvard Medical School and the National Sleep Foundation share the following advice to improve your sleep.

Routine and ConsistencyYour body has an internal “clock” that regulates your sleep. Going to bed and waking up at the same time each day will help improve your sleep and waking hours. By doing relaxing things before bed like taking a bath or reading a book, you help cue your body to prepare for sleep. On the other hand, doing stress-ful activities before bed can increase your alertness and make it difficult to fall asleep.

TemperatureOur body temperature naturally decreases as we begin to fall asleep and the air temperature in the room can affect sleep quality. If it’s too hot, our natural dip in body temperature can be affected, causing restlessness. While the most favorable temperature varies from person to person, research suggests that a temperature around 65 degrees is best for quality sleep.

LightAs darkness settles, our bodies pro-duce the hormone melatonin to help us prepare for sleep. Artificial light can hinder this process and trigger our brains to stay awake. Inspect your room for sources of light and consider using darkening curtains or shades to block out light. Make it a habit to keep light-producing electronics like cell phones, tablets, and TVs out of the bed-room.

SoundNoise can disturb your sleep, even in subtle ways that you do not remember upon waking. It is important to create a quiet and constant bedroom environ-ment to get quality sleep. White noise can help drown out sounds that disturb sleep like doors shutting or cars pass-ing by. A fan, air purifier, or even a white noise app and speaker can provide a consistent background sound. Avoid using a TV as your noise filter since the sounds and light constantly change.

SmellThe air you breathe can positively or negatively affect your sleep. Studies suggest that the smell of lavender can have relaxing effects (even to the point of lowering blood pressure and heart rate). Using lavender essential oils or lavender scented candles before bed may help prepare you for a good night’s sleep.

Conversely, allergens can prevent or interrupt a good night’s sleep. To reduce allergens in your environment,

wash bedsheets in hot water once a week and blankets regularly. Also, use an air purifier that removes allergens, and keep windows closed when pollen counts are high.

FoodSome research suggests that foods containing the amino acid tryptophan can make you drowsy, helping prepare you for sleep. Turkey, eggs, chicken, fish, and nuts are common sources. But remember: Eating big meals or foods that upset your stomach before your regular bedtime can cause you discom-fort and make it hard for you to sleep. So can alcohol (which has both sedative and stimulant effects) and true stimu-lants like caffeine.

Sleep is essential to our health and productivity. Make a conscious effort to establish bedtime routines and cre-ate an environment that improves your sleep quality. Talk with household members and seek their support. For more sleep tips and research, visit the National Sleep Foundation website and the Healthy Sleep website from Harvard here:

sleepfoundation.org/bedroom

healthysleep.med.harvard.edu/healthy/getting/overcoming/tips

Not Just DreamingStrategies for Better Sleepby Pete Arens, MS, CHES Wellness Manager

65% of Americans say they are more effective when they get enough sleep.

NEWS FROM MEDCOR | SUMMER 2018 P5