Daniel B. Gold

The impact of a worksite Health promotion program on short-term disability usage

This study examined the impact of a worksite health promotion program on short-term disability (STD) days in a large telecommunications company. The evaluation used a quasi-experimental, multiple time-series design with between-group comparison of workdays lost due to STD to determine impact. The study period was 3 years and included 1628 employees on STD leave. Self-selected program participants were compared with non-participants on net days lost at three assessment points: the year before the launch of the program, and each of 2 years post-launch. A comprehensive health promotion program was developed to reduce health care costs, improve employee satisfaction, and enhance the employer’s image. Key features of the program included reimbursement for employees participating in the Health Risk Assessment and in wellness or fitness activities. Other features included occupational health services, targeted interventions for high-risk employees, self-care materials, and a nurse advice line. Results revealed no significant differences at baseline between participants and non-participants for net days lost while on STD leave. At the post-program launch, non-participants’ net days lost significantly increased from 33.2 to 38.1 when controlled for age, gender, job type, tenure, and STD category, whereas the participant group average net days lost decreased from 29.2 to 27.8. After adjusting for baseline differences, we found a 6-day difference between groups, which represented a 20% program impact. This study found that participation in a health promotion reimbursement program had a significant impact on average net days lost for employee STD absence. These findings represented potential savings in excess of

The relationship between health promotion program participation and medical costs: a dose response.

1,371,600 over a 2-year period. Future program evaluation efforts will address the impact on medical care costs related to program participation.

The impact of behavioral health risks on worker absenteeism.

The purpose of this research was to determine whether participation in the health risk assessment (HRA) component of a comprehensive health promotion program has an impact on medical costs, and whether the addition of participation in interventions has an incremental impact. Program participants (n = 13,048) were compared with nonparticipants (n = 13,363) to determine program impact on paid medical costs. Overall, HRA participants cost an average of

Conceptual framework, critical questions, and practical challenges in conducting research on the financial impact of worksite health promotion.

212 less than eligible nonparticipants. As HRA participation increased, cost savings also increased. Additionally, although participation in either an HRA or activities alone resulted in savings, participation in both yielded even greater benefits. The findings indicate that there is an independent benefit of each of these elements of participation, and that the sum of the elements provides a greater benefit than the impact of either of the individual elements alone.

Guidelines for Analysis of Economic Return from Health Management Programs

The relationship between behavioral health risks and worker absenteeism was investigated. Data on absenteeism and on 10 behavioral health risk areas were collected from 35,451 employees. Analyses examined whether higher health risks are associated with higher absenteeism, and whether a reduction in health risks translates into a reduction in absenteeism. Results revealed that a significant relationship existed between health risks and absenteeism in 8 of the 10 risk areas examined. Individuals who are at risk are more likely to be absent than individuals at low risk. Additional analyses revealed that individuals who reduce their risks in the areas of mental health, stress, and back are absent less often than individuals who remain at risk. These findings suggest that absenteeism, and the costs associated with it, may be controlled by health promotion programs and the reduction of health risks.

Impact of a telephone-based intervention on the reduction of health risks.

A conceptual framework to guide research on the financial impact of health promotion programs is described. Important questions that must be answered within this framework are discussed and brief summaries of the research addressing these questions are summarized. Key issues and challenges that are encountered in designing and implementing financial outcome research are reviewed.

The Predictive Validity of the HERO Scorecard in Determining Future Health Care Cost and Risk Trends

Double-digit health care inflation and an increasing focus on improving workforce productivity are substantive challenges for virtually all employers. Conventional health care cost management strategies (e.g., cost shifting, network discounting) have not been enough to stem the tide, and employers have increasingly turned to alternative strategies, such as health and productivity management, to target the root causes of these problems and achieve sustained improvements. Mercer’s 2005 National Survey of Employer Sponsored Health Plans indicates that more than 62% of large employers (500 or more employees) and 81% of jumbo employers (20,000 or more employees) view health management as a ‘‘significant’’ or ‘‘very significant’’ strategy to address increasing health care costs. The marketplace is aggressively trying to address these concerns and capitalize on the opportunity—leading to a fluid, complicated, and changing marketplace because of increased investments by employers in health and productivity management programs. As companies invest more in health management programs, a need has emerged for comprehensive evaluation of their impact on changing behaviors, improving health, and managing health costs—as well as determining their economic return and overall return on investment (ROI). Additionally, most employers and providers lack the capabilities to determine the full impact of these investments in a way that demonstrates cause-and-effect relationships, for plausible impact analyses and ROI can be hampered by real-world limitations. As health management programs become commonplace, health-and-benefits professionals, actuaries, and payers need to understand both how these programs affect medical trend and how to make the appropriate adjustments required for both shortand long-term business decisions, thus the guiding purpose for this edition of The Art of Health Promotion. For the purposes of this article, the use of the term employer connotes both employer-sponsored and health-plan–sponsored programming efforts. In this edition of The Art of Health Promotion, we will cover the following issues:

Do employee health management programs work

Purpose. Evaluate the long-term impact of telephone-based interventions that target high risk, ready-to-change individuals. Design. Quasi-experimental design with pre/post comparisons of lifestyle-related health risks between participants and nonparticipants. Setting. Six organizations from the private and public sectors. Subjects. Subjects were 607 intervention participants who were compared with a control group of 1134 eligible nonparticipants. Measures. Health risk assessment at baseline and at an average of 2 years later measured risk in 13 lifestyle areas. Intervention. Programs were offered in seven areas: back care, cholesterol control, eating habits, exercise and activities, stress management, tobacco use, and weight control. Each program was conducted by a trained health educator who provided information and counseling to facilitate change in the area selected by the participant. All counseling was done by telephone and included three to five contacts over a 1-year period. Results. Binary logistic regression models controlling for gender and age revealed both specific and general effects. Participants were 1.8 to 3.5 times as likely as nonparticipants to reduce the targeted risk in six of seven risk areas. In addition, participants were 1.7 to 3.5 times as likely as nonparticipants to reduce their risks in nine of 13 areas not targeted by the intervention (i.e., general effect). Overall, participants significantly reduced their number of risks, whereas nonparticipants significantly increased their risk (difference of .85 risks). Conclusions. Results show that at-risk participants make long-term improvements in health risks directly related to the intervention in which they participate. Results also suggest that this intervention may help individuals develop behavior-change skills they can apply to other lifestyle issues.

Impact of a comprehensive population health management program on health care costs.

Objective: To determine the ability of the Health Enhancement Research Organization (HERO) Scorecard to predict changes in health care expenditures. Methods: Individual employee health care insurance claims data for 33 organizations completing the HERO Scorecard from 2009 to 2011 were linked to employer responses to the Scorecard. Organizations were dichotomized into “high” versus “low” scoring groups and health care cost trends were compared. A secondary analysis examined the tools ability to predict health risk trends. Results: “High” scorers experienced significant reductions in inflation-adjusted health care costs (averaging an annual trend of −1.6% over 3 years) compared with “low” scorers whose cost trend remained stable. The risk analysis was inconclusive because of the small number of employers scoring “low.” Conclusions: The HERO Scorecard predicts health care cost trends among employers. More research is needed to determine how well it predicts health risk trends for employees.

Chapter 14: Fairview Alive—An Integrated Strategy for Enhancing the Health and Well-Being of Employees

Current peer review literature clearly documents the economic return and Return-on-Investment (ROI) for employee health management (EHM) programs. These EHM programs are defined as: health promotion, self-care, disease management, and case management programs. The evaluation literature for the sub-set of health promotion and disease management programs is examined in this article for specific evidence of the level of economic return in medical benefit cost reduction or avoidance. The article identifies the methodological challenges associated with determination of economic return for EHM programs and summarizes the findings from 23 articles that included 120 peer review study results. The article identifies the average ROI and percent health plan cost impact to be expected for both types of EHM programs, the expected time period for its occurrence, and caveats related to its measurement.