U.S. employers have increased their expenditures on health-care management programs by 50 percent over the last two years, according to the 2011/2012 Staying@Work Survey Report from Towers Watson and the National Business Group on Health. A significant majority of U.S. and Canadian respondents, 89 percent and 87 percent respectively, said health and productivity is a key component of their overall health-care strategy.
Employers are making a greater effort to improve their employees’ health through wellness programs, health risk assessments and programs that encourage a more healthful culture. Workers are encouraged to improve their fitness and nutrition habits, develop lasting relationships with their doctors and be more accountable for their own health-care costs.
Dr. Randy Wexler, associate professor and clinical vice chair of the Department of Family Medicine at Ohio State University, has seen an increase in the number of patients asking for routine physical exams, as well as a decrease in no-shows for such appointments. “Five years ago, I might have seen one physical a day. Now it’s not uncommon for me to see two or three,” he says. “I’d say the vast majority of the increase is specifically related to employer incentives. More are requesting specific tests, which are required.”
Such pushes on health and wellness can improve the health of many workers. But they also improve the health of employers’ bottom lines. According to the Staying@Work study, U.S. respondents with highly effective health and productivity programs reported a cost savings of more than $1,000 per employee over low-effectiveness companies.
Nationwide’s comprehensive wellness program, launched in 2006, resulted in a 24 percent decrease in health-care costs for employees who were deemed low risk through health risk assessments (HRAs) last year. The population of employees older than 50 who are low risk spent as much as 36-year-olds who are high risk. “It’s not aging, it’s aging with risk factors. Getting it down to one to two risk factors really makes a huge difference,” says Kathleen Herath, associate vice president of health and productivity for Nationwide.
Healthier employees are more productive and absent less. Combined with initial health-care cost savings, fewer lost days can increase total savings by 30 percent, according to the Staying@Work study.
“The people who don’t take the time to take care of themselves will get worn down. That will affect productivity and family life,” says Rebecca Nguyen, manager of health promotion at Battelle. “People are happier employees at the end of the day if they feel like Battelle cares about them. If the employee feels cared about, they will be much more invested.”
“Obviously it’s not just about improving employee health, but the family members’ health, too,” says Dr. Bill Gegas, medical director for Worthington Industries. “If you can keep their families healthier, that means less time away for the mother or father of a child. That’s why we stress preventative care, including vaccinations.”
Proponents cite several programs as examples of what collaboration between insurance companies, medical providers and employers can do. One is a YMCA diabetes prevention program offered to 4,000 people throughout the country, including more than 500 from Central Ohio, that’s fully covered by UnitedHealth Group. The classes teach participants to plan meal portions, read nutrition labels and add exercise to their daily routine. Participants lost an average of 5 percent of their body weight.
Locally, Cigna and Mount Carmel Health Partners have a collaborative accountable care program, which aims to boost health outcomes, affordability and patient satisfaction. Much like accountable care organizations, the initiative focuses on high-risk individuals, such as the chronically ill.
“We’re coordinating information we share from our systems. They receive information from us, it’s fed into their organization, and they feed it to the physicians,” says Vince Sobocinski, Cigna’s president and general manager for the Keystone and Great Lakes region.
A patient on asthma medication, for example, might have neglected to fill his latest prescription. Information from Cigna will alert the patient’s physician. “They, in turn, can reach out to the patient,” Sobocinski says. “Physicians want to practice this way. They want to be more engaged, and we’re giving them the ability to do that.” Cigna has a similar relationship with Health4, a group of physicians from the Medical Group of Ohio and OhioHealth hospitals, called the pay for quality initiative.
Mount Carmel is no stranger to collaboration, having partnered with employers such as Franklin University for more than 20 years. Its Workplace Health program helps employers identify and manage employee health risks. “I work with employers in the Columbus area to coordinate on-site wellness service. That can range from biometric screenings, preventionary presentations, flu shots—really anything wellness related that can be brought on-site,” says Katie Kinzig, employer relations specialist for Mount Carmel. “It’s definitely a growing industry. More companies are becoming educated and seeing its importance. They understand why it’s so important to improve health before it becomes a larger issue.”
Health Risk Assessments
Employers use HRAs as a key tool, says Nitin Bhargava, president of the Ohio and Kentucky markets for Aetna. “Employers are looking to start with those initiatives that are more tangible. They’re less interested in something that might take years.”
Questions about family history, lifestyle choices and a variety of other topics help determine risk factors. Cigna members are assessed through a questionnaire developed by the University of Michigan, with questions ranging from biometric measures to seatbelt use. Cigna’s HRA predicts with 83 percent accuracy the probability of becoming a Type 2 diabetic, Sobocinski says.
“If you can identify a potential Type 2 diabetic and predict that in advance of that occurring, you can set into motion certain health-care processes to protect that individual, so that they don’t move into that higher level. The cost level between a pre-diabetic and a diabetic in the two class is significant, and once that patient moves to that level, he can’t come back down again,” Sobocinski says.
Cigna guarantees employers it will move a high-risk employee to moderate risk within 14 months. If that goal is not met, Cigna will fund $1,100 of additional health and wellness programs. “What we’re really saying is we’ll commit to take you through our medical management processes and drive those top-tier health risks to a lower tier. That translates to real dollar savings,” Sobocinski says.
At Nationwide, the number of associates identified as low-risk (zero to two risk factors) increased from 45 percent in 2006 to 73.6 percent in 2012; high-risk employees (five or more risk factors) are at 7 percent. To boot, more employees are participating in the HRA. “Those are both the gold standard—above 70 percent and below 10 percent,” Herath says. “In the beginning, we had 60 percent participating. Over the last couple of years, we’ve had about 90 percent participation.”
“We’ve seen our use of HRAs rising, but we’re working very hard to increase that percentage of employees who use it. You need the right setting culturally and philosophically. If you have a CEO who is heavily engaged in viewing health care as an important part of the overall organization, and that messaging is top-down across the organization, you’ll see more focus on it,” Sobocinski says. “Where I see it not happening is employers who may give it lip service, but are not seriously focused on improving the health of their employees. They view their health-care environment as administering a plan, as opposed to the broader concept of working to improve employees’ health.”
John H. McConnell, founder of Worthington Industries, launched the company’s wellness program in 1985 with the opening of a fitness center. In 1995, a medical center was added. Today, the fitness center offers exercise and yoga classes in the morning and boasts an exercise physiologist who can tailor workouts to specific employee needs.
The company offers on-site blood pressure screenings, flu vaccines, smoking cessation programs and online training and education for weight loss and nutrition. It also offers a voluntary HRA.
“We generally have focused on preventative care and education for our patients. Worthington has sponsored on-site health fairs at plants across the country,” Gegas says. “As medical director, I will visit approximately 20 to 25 plants a year and do consultations with employees regarding risk factors, cholesterol profiles and blood sugar. It’s an opportunity to discuss with physicians one-on-one.”
Nationwide’s program includes a health assessment and screening, as well as comprehensive programs for weight loss, stress, diabetes and supportive cancer care. Employees can also maintain their cognitive health with a brain solutions program that improves focus, memory and the ability to multitask. “We’ve looked at our health-care data in 2011, and this year we added asthma as a disease management program because we found it was an area where folks had gaps in care and could benefit,” Herath says.
Battelle launched its In Shape wellness program in 2011, offering a variety of initiatives including annual biometric screenings, three-hour farmers markets on Fridays and walking contests. In May, 120 Central Ohio employees met in the lobby of the King Avenue headquarters for Circle Battelle Day, walking around the outside of the building; participation doubled over the previous year. All Battelle offices participate in the annual walking contest.
Battelle’s King Avenue and Dublin locations include fitness centers where employees can take classes in yoga, aerobics and boot camp. A meditation instructor hosts a weekly meditation community for stress relief, and personal training is offered by Nguyen.
The cafeteria features signs with nutritional content and health recommendations. Indoor walking paths of a half-mile and an eighth of a mile encourage employees to fit in some exercise at work. “Employees can walk during their lunch break, or any time they need a break,” Nguyen says. “We also have a holistic doctor for preventative health consults. They can meet with her, get advice on everything from nutrition to stress management offered free of charge.”
At Aetna’s New Albany office, an employee wellness committee selects programming, including guest speakers and Zumba classes. Two treadmills attached to an elevated desktop, complete with phone and computer, are set to a maximum speed of 2 mph for those who want to work out while they work.
Incentives can greatly increase employees’ participation in wellness programs and risk assessments. Respondents to the Staying@Work study reported average participation rates of 46 percent when incentives are provided, compared with 19 percent when they are not. While many employers offer premium reductions, health savings account contributions or discounted gym memberships, others opt for a firmer take-it-or-leave-it approach.
“That’s becoming a more frequent situation. There are some who simply mandate that if you don’t take the HRA, you and your spouse, you will not have health benefits,” Sobocinski says. “That’s still a minority, but we’re seeing more of that. When you do that, participation moves from 30 to 40 percent up to 98 percent.”
“Employers are trying to figure out, based on culture and strategy, what works best. Is it a carrot or a stick approach?” Bhargava says.
Aetna offers a variety of incentives for its own employees. For example, passing three of the five standards measured in metabolic syndrome testing (blood pressure, blood glucose, triglycerides, waist circumference and HDL cholesterol) will result in a $600 premium reduction. Those markers are a key indicator for several risk factors, including heart disease and diabetes. “This past year, we included employees’ spouses. They didn’t need to pass, but if they got tested there was a premium cut. The whole point is engagement,” Bhargava says.
Aetna’s HRA is voluntary, but is a prerequisite for participation in the Get Fit Aetna program, which offers up to a $500 annual health savings account credit for using an online tool that tracks exercise and food intake. Discounted gym memberships also are offered. The point, Bhargava says, is moving workers from awareness and engagement to the next step.
Worthington Industries associates with identified risk factors can join one of several company programs, completion of which can bring up to a $600 premium reduction per year. “For instance, you have a 55-year-old individual who eats poorly, has hypertension and borderline diabetes. He voluntarily signs up for an online nutrition program and a pre-diabetes program. He is required over the year to complete both of those programs and, as long as he maintains those, he gets the credit,” Gegas says.
At Nationwide, employees themselves tout the benefits of the wellness program. “We have done everything to the voice of our associates. We encourage them to tell the story of why they did it. We talked to an employee who has lost 93 pounds and run five or six marathons. He talked about how important it was to talk about his numbers,” Herath says. “We don’t use clip art. Everything we do for our associates is from the voice of the associate—every poster, every testimonial. They tell the story far better than I ever could.”
Michelle Davey is a freelance writer.
Reprinted from the November 2012 issue of Columbus C.E.O. Copyright © Columbus C.E.O.