R. William Whitmer

The relationship between modifiable health risks and health care expenditures: An analysis of the multi-employer HERO health risk and cost database

This investigation estimates the impact of ten modifiable health risk behaviors and measures and their impact on health care expenditures, controlling for other measured risk and demographic factors. Retrospective two-stage multivariate analyses, including logistic and linear regression models, were used to follow up 46,026 employees from six large health care purchasers for up to 3 years after they completed an initial health risk appraisal. These participants contributed 113,963 person-years of experience. Results show that employees at high risk for poor health outcomes had significantly higher expenditures than did subjects at lower risk in seven of ten risk categories: those who reported themselves as depressed (70% higher expenditures), at high stress (46%), with high blood glucose levels (35%), at extremely high or low body weight (21%), former (20%) and current (14%) tobacco users, with high blood pressure (12%), and with sedentary lifestyle (10%). These same risk factors were found to be associated with a higher likelihood of having extremely high (outlier) expenditures. Employees with multiple risk profiles for specific disease outcomes had higher expenditures than did those without these profiles for the following diseases: heart disease (228% higher expenditures), psychosocial problems (147%), and stroke (85%). Compared with prior studies, the results provide more precise estimates of the incremental medical expenditures associated with common modifiable risk factors after we controlled for multiple risk conditions and demographic confounders. The authors conclude that common modifiable health risks are associated with short-term increases in the likelihood of incurring health expenditures and in the magnitude of those expenditures.

Presenteeism According to Healthy Behaviors, Physical Health, and Work Environment

The objective of this study is to identify the contribution that selected demographic characteristics, health behaviors, physical health outcomes, and workplace environmental factors have on presenteeism (on-the-job productivity loss attributed to poor health and other personal issues). Analyses are based on a cross-sectional survey administered to 3 geographically diverse US companies in 2010. Work-related factors had the greatest influence on presenteeism (eg, too much to do but not enough time to do it, insufficient technological support/resources). Personal problems and financial stress/concerns also contributed substantially to presenteeism. Factors with less contribution to presenteeism included physical limitations, depression or anxiety, inadequate job training, and problems with supervisors and coworkers. Presenteeism was greatest for those ages 30-49, women, separated/divorced/widowed employees, and those with a high school degree or some college. Clerical/office workers and service workers had higher presenteeism. Managers and professionals had the highest level of presenteeism related to having too much to do but too little time to do it, and transportation workers had the greatest presenteeism because of physical health limitations. Lowering presenteeism will require that employers have realistic expectations of workers, help workers prioritize, and provide sufficient technological support. Financial stress and concerns may warrant financial planning services. Health promotion interventions aimed at improving nutrition and physical and mental health also may contribute to reducing presenteeism.

Self-Rated Job Performance and Absenteeism According to Employee Engagement, Health Behaviors, and Physical Health

Objective: To better understand the combined influence of employee engagement, health behavior, and physical health on job performance and absenteeism. Methods: Analyses were based on 20,114 employees who completed the Healthways Well-Being Assessment from 2008 to 2010. Employees represented three geographically dispersed companies in the United States. Results: Employee engagement, health behavior, and physical health indices were simultaneously significantly associated with job performance and also with absenteeism. Employee engagement had a greater association with job performance than did the health behavior or physical health indices, whereas the physical health index was more strongly associated with absenteeism. Specific elements of the indices were evaluated for association with self-rated job performance and absenteeism. Conclusion: Efforts to improve worker productivity should take a holistic approach encompassing employee health improvement and engagement strategies.

Gender-specific Effects of Modifiable Health Risk Factors on Coronary Heart Disease and Related Expenditures

There is a general lack of health-related research focusing on gender-specific differences within a working population. This research attempts to address that void. Our study relied on the Health Enhancement Research Organization (HERO) database, which consists of claims, enrollment information, and health risk data for 39,999 employees of six large employers. The research objective was to determine the gender-specific association between coronary heart disease (CHD) and (1) the prevalence of modifiable health risks and (2) medical expenditures. To accomplish this, the International Classification of Diseases, 9th Revision–Clinical Modification and Current Procedural Terminology codes were used to identify 2452 employees with CHD within the HERO database. These individuals made up the study group, which included 66% male and 34% female participants. Health risk data were obtained from voluntary participation in a health risk appraisal and biometric evaluation provided by the employers. Health risks evaluated were tobacco use, hypertension, obesity, elevated cholesterol, high blood glucose, sedentary lifestyle, stress, depression, and excessive use of alcohol. Descriptive and multivariate statistical techniques were used to analyze the HERO database. We found that obesity was the most consistent predictor of CHD. It was number one (of 10 health risks) in the male and female group, number two in the male-only group, and number one in the female-only group. High stress was the second most consistent predictor. There was no such consistency relative to medical expenditures. This lack of consistency across the male and female groups relative to the association between health risks and medical expenditures was demonstrated for nearly all other health risks evaluated. This study suggests that within a group of employees with CHD, there are important similarities and differences between men and women with respect to the prevalence of risk factors and the association between health risks and medical expenditures.

The Impact of Worksite Wellness in a Small Business Setting

Objective: This study evaluates the level of participation and effectiveness of a worksite wellness program in a small business setting. Methods: Three years of wellness participation and risk data from Lincoln Industries was analyzed. Results: All Lincoln Industry employees participated in at least some level of wellness programming. Significant improvements in body fat, blood pressure, and flexibility were observed across time. The largest improvements in risk were seen among older employees and those with the highest baseline values. Conclusions: This small business was able to improve the health of the entire workforce population by integrating wellness deeply into their culture and operations. Replication of this program in other small business settings could have a large impact on public health since 60 million adults in the United States work in small businesses.

Evaluation of a Best-practice Worksite Wellness Program in a Small-employer Setting Using Selected Well-being Indices

Objective: To measure the effectiveness of a wellness program in a small company using four well-being indicators designed to measure dimensions of physical health, emotional health, healthy behavior, and basic access to health-related conditions and services. Methods: Indicator scores were obtained and compared between Lincoln Industries employees and workers in the neighboring Lincoln/Omaha community during 2009. Results: Nearly all Lincoln Industries employees participated in the wellness program. Physical health, mental health, and healthy behavior were significantly greater for Lincoln Industries employees. Self-perceived access to basic needs was not significantly greater among Lincoln Industries employees. Conclusion: Well-being index scores provide evidence for the effectiveness of the wellness program in this small company setting with respect to better dimensions of physical health, emotional health, and healthy behavior than geographically similar workers.

The Health Enhancement Research Organization (HERO).

An opportunity has been presented to the health promotion and disease prevention community by traditional mainstream medicine. For decades, the majority of health care providers operated through a fee-for-service system. It was a blank check policy with few, if any, controls. The more physicians did, the more they were paid. The more services delivered, the greater the revenue. As a result, the cost of health care increased an average of 20% per year during the 1980s. 1 This has caused the health care delivery system to undergo unprecedented changes. They range from a failed attempt at sweeping federal control 2

Is It Time ... for a National Health Promotion Research Agenda

During the past several years, health promotion activities have come under close scrutiny relative to data on the reduction of modifiable risks and the economic impact of risk factors. With regard to risk reduction, O’Donnell et al. 1 have pointed out that many health promotion programs have significandy reduced health risks among program participants. The data are not as plentiful relative to economic impact. Aldana 2 undertook a comprehensive review of all health promotion studies that were peer reviewed and published between 1975 and 1997. The intent was not only to determine the financial impact, but also to examine the methodological quality of each study. He concluded that even though some studies demonstrate positive financial returns, research needs to be improved in terms of research design, sample size, and statistical analysis. Private sector-sponsored health promotion research is not well organized at the national level. It is fragmented, with little coordination across research efforts. That which is reported in the literature is usually initiated unilaterally by employers, universities, or health promotion providers. Numbers of study subjects are small, and often, study design is questionable. Long-term impact is unclear. This is an opportune time to initiate a closer examination of health promotion research. Many sources are pre-