It's no secret that employers are trying hard to cut their health care bills. Many companies have shifted costs to employees and used managed care to restrict access to physicians. But organizations also are discovering there are limits and even drawbacks to saving money through cuts in the supply of health care.
A growing number of companies have found they can save money and improve productivity by attacking the demand for health care, through programs aimed at preventing employees from getting sick in the first place.
Last year, DaimlerChrysler won the Department of Health and Human Services' "Innovation in Prevention Award," a recognition intended to highlight organizations that are promoting healthy lifestyles.
How does the Auburn Hills, Mich., automaker's program work? And is there a connection between health promotion and more traditional health and safety protection?
DaimlerChrysler, in conjunction with the United Auto Workers (UAW), started its National Wellness Program (NWP) in 1985 and it has been growing ever since, according to Kate Kohn-Parrott, director of integrated health care and disability for DaimlerChrysler.
"We see a drop in health care expenditures of $6 to $8 million a year," says Kohn-Parrott. "We also believe the program decreases absenteeism, 'presenteeism' and workers' compensation costs, while improving productivity, but we can't directly measure this." Presenteeism refers to the problem of employees who show up for work, but aren't fully "present" or productive.
Improved morale appears to be another hard-to-measure benefit of the program. "After we started it, there was a spark in people's eyes they didn't have before," asserts Kohn-Parrott.
Kohn-Parrott explains that DaimlerChrysler does not provide the NWP itself, but contracts with three suppliers of wellness programs.
Of the three wellness program providers, StayWell Co. is by far the largest, with programs in 28 of the automaker's 36 sites. StayWell's national headquarters are in Yardley, Pa. The Wellness Institute of America in Southfield, Mich., and HealthyLife of Farmington Hills, Mich., are the other two providers.
Joan Bassing, national director of program management for StayWell, explains why health promotion is a growing business.
"If you think about HMOs, the whole goal was to restrict access and control costs," she says. "Everyone has done as much as they can on that end, but no one has touched the ultimate reason people go to the physician in the first place."
Bassing contends that aside from accidents and family history, a person's behavior is the largest driver of illness. "So all these companies that have tried everything else are saying, 'We need to educate the employees, empower them to take care of themselves, and hold them accountable for their own health.'"
By way of explanation about holding people accountable, Bassing predicts that in the future, the best health plans with the lowest premiums will go to those who avoid diseases and who only go to the doctor when they need to. In fact, the two basic components to the StayWell approach are based on this premise. First, workers are encouraged to eat well, exercise and do everything possible to stay healthy. Second, StayWell has a "self-care program" that gives people the tools they need to avoid going to the doctor unless it is truly necessary.
Ultimately, StayWell and the other program providers have the same mission as traditional safety and health protection professionals: changing human behavior. "We're evaluated on how well we help employees to make a behavior change that results in health care cost reductions, improved productivity and reduced absenteeism," says Bassing.
The health risk assessment, a behavior lifestyle survey, is the "foundation of our program," says Debbie Brandt, StayWell's program manager for the DaimlerChrysler account. It allows the health promotion professionals to do target marketing based on the needs of particular individuals or a specific site.
"After you've filled out the survey, if we see you live a sedentary lifestyle, use tobacco or have lots of stress, then I'd say, 'You might need some help, so let me send you an invitation to one of our follow-up programs based on your risk areas,'" explains Brandt.
StayWell has a call center with experts in behavior modification. "A registered dietician may call those who have a bad diet, or an exercise physiologist calls people who don't exercise to discuss how to change that behavior," says Bassing.
Brandt points out that she doesn't rely only on health risk assessment data to drive her program. "DaimlerChrysler gets the disability information, so we incorporate the highest work-related risk areas into our program plans for individual worksites," she says.
It is here that health promotion overlaps with traditional environmental, health and safety protection. The level of cooperation varies from site to site; Brandt singles out ergonomics as the most fruitful area to integrate her work with occupational health and safety professionals.
"There are all kinds of scenarios where they work together," agrees Cyndy Parker, RN, DaimlerChrysler's care management manager. "Wellness providers often work with our health and safety professionals to do ergonomics, back programs, fitness testing and an individualized exercise program." One cooperative program between StayWell and DaimlerChrysler's traditional health and safety staff involves workers who go to the company's occupational health clinics with a work-related concern.
"Even if it's just a headache, we coordinate with the wellness people to get education on how to manage blood pressure if it's high," says Parker.
Although there are opportunities for cooperation between EHS staff and health promotion, StayWell insists that it's a sound investment for organizations to hire dedicated specialists.
"Companies usually just take an occupational health nurse and say, 'In addition to your regular job, put on a wellness hat and do wellness things,'" Bassing says. What's wrong with that? "Ask an occupational nurse who is already overworked," she replies. While some nurses might love prevention work and embrace it, others could find it a burden.
Second, if each occupational nurse runs an ad hoc program at a particular facility, the program might be customized for local issues but it could miss the big picture. "The way to get where you want to go as a corporation is by taking your cost data, designing a program around it, and then evaluating the delivery of the program," asserts Bassing. "What I see when they assign this to occupational health nurses is they end up evaluating the program only on participation and satisfaction indicators." While those are important measures, what's crucial is helping workers to make a behavior change that will cut costs and improve productivity and that's how DaimlerChrysler evaluates StayWell.
"Because we know we spend a lot of money on cardiac issues, diabetes, asthma, lower back and mental health, we say these are the areas where we need to assist our employees to help reduce our health care costs," says Kohn-Parrott. The company also looks at disability data for each plant, according to Parker.
Third, to be successful, health promoters must have expertise in several fields that could be beyond many occupational health nurses, for example:
- Marketing and communications;
- Workshop or event organization;
- Health behavior modification.
Finally, Kohn-Parrott says employees are more likely to share their personal medical information with a third-party health provider than with their employer. "This is a private relationship between employees and wellness providers," she says. "We have no access to the individual information." DaimlerChrysler does see the aggregated data, however.
"Some companies will start a wellness program and run it through their HR department," adds Brandt. "But this could hurt participation because of confidentiality concerns people worry they will be fired if their cholesterol is high."
"It is by far the most comprehensive program we deliver and the most 'turnkey,'" says Bassing, when asked how the DaimlerChrysler program differs from other StayWell accounts. "They ask us to do everything, from soup to nuts."
One distinctive feature of the program is that StayWell has an onsite person for all DaimlerChrysler facilities with at least 500 employees. Plants with 2,500 workers have two wellness specialists and the number climbs to three at worksites with 5,000 employees.
"That's unique," comments Brandt. "It gives us the opportunity to offer the full range of programs, instead of just doing a campaign."
A second advantage of the onsite presence is it makes it possible for the health promoter to develop a personal rapport with the workers whose behavior she is trying to change.
"It definitely helps to change behaviors when you have established a relationship with the person," says Brandt. People are more likely to share their health concerns with someone whom they trust.
Moreover, part of a wellness provider's job is to discern the depth of a person's inner commitment to change. StayWell prides itself on mastering the research data on the various stages a person goes through in giving up smoking or taking up exercise. Personal rapport is crucial in determining whether, and how much, the worker is ready to change.
"Knowing there's someone there to follow up with them is a motivational factor as well," says Brandt.
Susan Crabtree, benefits coordinator for UAW's DaimlerChrysler department, offers a third benefit to having wellness professionals onsite. Crabtree worked at a plant 3 years ago and she says she made use of the weight loss and exercise program. "I liked the convenience of it being right where I was working," she explains. "They have 'lunch and learn,' so they get the information to you and I don't have to go somewhere else after I get off."
In fact, the only criticism from workers Crabtree hears about the program seems to underscore the value of DaimlerChrysler's distinctive onsite approach.
"The only complaints I ever hear," she says, "is that it's still hard to find time because of the work schedule. Some workers are so tired when they get a break it's hard to walk anywhere." Crabtree explains that since breaks last only 12 minutes and lunches are a half hour long, it can be hard for workers to meet with wellness professionals even if they are onsite. It is especially challenging to reach night shift workers, she added.
"But even if we only reach 70 percent [of our membership], that's better than nothing," Crabtree says.
Return on Investment
"We have phenomenal cooperation with the UAW," says Kohn-Parrott. Union participation appears to be an essential component of the wellness program's success. One measure of this is the level of participation in the health risk assessment. It stands at 41 percent annually and is rising every year, according to Kohn-Parrott.
Bassing says the participation rate is 75 percent on a 3-year basis, just shy of the goal of 80 percent.
Until now, the company has used only minimal "carrots," such as T-shirts for those who complete the health risk assessment. There are no "sticks"; the program is completely voluntary. DaimlerChrysler also has offered up to $150 to employees who promised to move to healthy behaviors not smoking, for example. The problem with this was that too many workers qualified for the money without really changing their behavior, says Kohn-Parrott.
But now, convinced that the wellness program is saving the company real money, Kohn-Parrott plans to bump up the incentives and the requirements. "We will give workers $120 credit on their insurance premium if they take the HRA and another $120 if they have a glucose, blood pressure and cholesterol check once a year," she says. While DaimlerChrysler has 80,000 employees, because of collective bargaining agreements, the more ambitious incentive plan applies only to the 20,000 workers who don't belong to the UAW. But company officials expect the incentives to boost participation among these workers to 80 percent.
DaimlerChrysler's program is not cheap and companies without a wellness program may be skeptical about whether investing in it will pay off. The fact that DaimlerChrysler is willing to put still more money on the table (up to $1.8 million) is one sign the company is convinced the program is cutting costs.
"We're excited employees can earn $240 a year to help offset health care premiums that means we're offering $90 more in incentives and we expect to save double that," says Kohn-Parrott. "We think that's an excellent return on investment."
For more information and articles about wellness programs and occupational health, visit our Occupational Health Safety Zone.