Prevention Matters

A prominent British economist writes in the Health Cost Monitor that the evidence is "is decidedly mixed" on whether financial incentives to improve health-related behaviors actually work.

"Financial incentives for specific areas of medical compliance appear to show some promise, but there is insufficient good evidence that they work in any sustained way to alter broader lifestyle behaviors," writes Adam Oliver, RCUK Senior Academic Fellow in Health Economics and Policy at the London School of Economics and Political Science. Oliver was also founding coeditor of the journal Health Economics, Policy, and Law.

"If they do not work, then they will clearly fail to reduce health care costs," he says. "The evidence is decidedly mixed."

A Health Affairs article reviews the evidence on workplace wellness programs and concludes that the medical savings outweigh the costs for employers.

The authors conducted a critical review of more than 100 existing peer-reviewed analyses of employee wellness programs, many of which use health risk assessments and focus on obesity and smoking, the top two causes of preventable death in the United States. They found that these initiatives save employers money both through reduced health costs for their employees and reduced absenteeism.  For every dollar spent on wellness programs, about $3.27 was saved in medical costs and $2.37 was saved in reduced workplace absenteeism.

"The Case for Wellness Programs: From Evidence to Practice," a Dec, 3 meeting in Washington DC sponsored by the U.S. Chamber of Commerce Foundation and Partnership for Prevention, is available for viewing online at http://www.uschamber.com/webcasts/2009/091203_ncf_wellness2009.htm .

The U.S. Chamber of Commerce and Partnership for Prevention today released a new guidebook - Healthy Workforce 2010 and Beyond - to help employers plan, implement, and evaluate workplace health promotion programs that lower health costs and boost productivity.

“We are committed to improving the health status of American workers,” said Randy Johnson, Senior Vice President of Labor, Immigration, and Employee Benefits for the U.S. Chamber of Commerce. “We can foster employee health by increasing the number of employers that include worksite health promotion and wellness programs in their benefits strategies.”

The book provides both private and public sector employers with information about the benefits of investing in worksite health promotion. It outlines current approaches and tactics that are supported by research findings or “promising practices” that are successful as part of wellness programs.

“Chronic diseases are significant drivers of health care costs, and a majority of American employees have at least one chronic condition,” said Partnership President Robert. J. Gould, PhD. “By practicing health management in the workplace, employers not only help workers live healthier lives, but they also improve employers’ bottom lines through reduced health costs and increased productivity.”

Using a program focused on tobacco, alcohol and drug abuse, physical inactivity, and obesity, the book explains how small, medium, and large organizations can take positive steps to achieve health objectives as part of a comprehensive health promotion program. It also highlights the current health status of American workers, and shows how to design workplace health programs that attain workforce health objectives.

Zac Bissonnette over at bloggingstocks.com says investors may find a path to profits by looking for companies that have wellness programs for their workers. He cites the 2009/2010 North American Staying@Work Report: The Health and Productivity Advantage from Watson Wyatt Worldwide.

"The study of more than 350 publicly traded U.S. and Canadian companies found that those with strong wellness and motivational programs had a total return to shareholders of 15% between 2004 and 2008," Bisonnette writes. "Shares of companies with the weakest programs lost an average of 10% over that time span. Revenue per employee was also higher at companies with strong wellness programs. Watson Wyatt notes that wellness programs lead to higher productivity and reduced sick days.

The Wall Street Journal reports that recently issued federal guidelines may throw a monkey wrench into the plans of employers who have or are planning to establish wellness rewards programs. The guidelines, aimed at protecting genetic information, prohibit health plans and employers from offering any financial rewards to any worker for participating in a health risk assessment that requests information about their family medical history.

Employers whose health plans aren't in compliance can face fines of up to $500,000. The rules apply to group health insurance with plan years beginning on or after Dec. 7. Employers and insurers have until Jan. 5 to submit comments, which means they could yet be revised.

Worksite programs help employees lose weight, according to a systematic review published in the October issue of the American Journal of Preventive Medicine. On the basis of strong evidence of their effectiveness, the U.S. Task Force on Community Preventive Services (Task Force) recommends worksite programs intended to improve diet and/or physical activity behaviors for reducing weight among employees. These programs include various approaches to support behavior change, such as informational and educational activities, behavioral and social strategies, and policy and environmental approaches.

Partnership for Prevention President Robert J. Gould told National Journal that more science is needed to properly evaluate workplace wellness incentives that base employees' insurance rates on their individual health status.

Gould's comments were included in an article by Julie Kosterlitz on proposed legislation that lets employers offer workers discounts of as much as 50 percent for meeting specific health goals, such as smoking cessation, obesity, blood pressure and cholesterol. That would change a 1996 law that forbids discrimination by group health plans against workers based on their health status.

"Some leaders in the field of wellness and prevention have chosen not to endorse proposed legislation to change the 1996 law," Kosterlitz writes. 'We need more information before we can jump in and support this,'" said Rob Gould, president of Partnership for Prevention, an organization of businesses, nonprofits and governemnt agencies that advocate wellness. 'There are some case examples presented by companies, but it's not the kind of systematic evaluation' the group needs to satisfy its concerns.'"

Senate Finance Committee Chairman Max Baucus (D-MT) has amended his version of the health reform bill to add a $200 million program to help small businesses establish wellness programs. The funding would allow the Secretary of Health and Human Services to make grants for up to five years to businesses with less 100 than full and/or part-time employees (to provide access to comprehensive, evidence-based workplace wellness programs.

Qualifying programs will include the following components to help employees make healthier choices: health awareness (such as health education, preventive screenings and health risk assessments), employee engagement (such as mechanisms to encourage employee participation), behavioral change (elements proven to help alter unhealthy lifestyles such as counseling, seminars, on-line programs, self help materials) and supportive environment (such as creating on-site policies that encourage health lifestyles, health eating, physical activity and mental health).

Grant money from this amendment would only be available for employers that are not already providing qualified wellness programs.

A column in BizTimes.com says worksite wellness programs "are showing a significant return on investment among companies across the U.S." Well City Milwaukee's Janet McMahon specifically cites the following programs:

• Johnson & Johnson's Healthy People program, which saves an estimated $9 to $10 million per year from reduced medical utilization and lower administrative expenses.
• Citibank's comprehensive health management program, which demonstrates for every dollar invested in programming activities, $4.56 to $4.73 was saved in reduced health care costs.
• Union Pacific Railroad's medical self-care program, which shows a cost savings of $2.78 for every dollar invested by reducing inappropriate emergency room and outpatient visits.
• Robert W. Baird & Co. Inc. in Millwauke, which launched its wellness program in 2006. In the past three years, Baird's health care cost trend has decreased from 13 percent per year to 7 percent per year, and it is expected to be lower in 2010 as well. In addition, preventable health risks, which are closely associated with health care costs, have decreased for Baird employees.

The U.S. Chamber of Commerce is offering companies new guidelines for coping with the H1N1 swine flu pandemic amid concerns that employers could face crippling absenteeism as the U.S. flu season takes hold. The 16-page guide, entitled "It's Not Flu as Usual: An H1N1 Business Preparedness Guide," offers scenarios in which more than 10 percent of staff are too sick to come to work on any given day over the course of several months to a year.

A new survey shows that most U.S. businesses are concerned that swine flu will have a negative effect on business if cases are widespread and severe this fall and winter. Most companies said they could handle some swine flu absenteeism, but not without major problems if a lot of workers were affected.

For instance, 73% of participants said their company could avoid severe operational problems if 20% of their workers were absent for two weeks. But if a third of their employees were out for that long, only 44% of companies said they could handle that without having severe operational problems, and only 33% were as confident about their ability to cope if half of their workers were out for two weeks.

CNN reports on the workplace wellness program at Quest Diagnostics, a Virginia company whose "Healthy Quest" program saves $4.80 for every dollar invested in it.

"Healthy Quest is designed to focus on health issues that 'drive a lot of costs, and drive a lot of lost productivity,' like obesity, smoking and stress, [Steve Burton, vice president of health and wellness services at Quest Diagnostics] said." Since its inception, "the company has benefited from lower health care costs, fewer sick days and more satisfied employees," he said.

Two of Partnership for Prevention's policy team will take part in a free Aug. 28 Wellsteps webinar entitled "How Will Health Care Reform Change Worksite Wellness?"

Garry Lindsay, Managing Senior Fellow and Senior Program Officer, and Ripley Forbes, Director, Legislative and Policy Advocacy, will take part in a panel discussion, which will take place from 11:00 a.m.-12:00 Noon EDT. Joining them will be Michael P. O'Donnell, MBA, MPH, PhD, the Editor in Chief of the American Journal of Health Promotion and Chairman of Health Promotion Advocates. Steven G. Aldana, Ph.D., a former professor of lifestyle medicine at Brigham Young University, who is currently the CEO and founder of WellSteps, will moderate the panel discussion.

Wellsteps is a turnkey wellness program designed to help employees adopt and maintain healthy behaviors for life. WellSteps webinars feature “the nation's leading worksite wellness experts” who share best practices, programming ideas, and evidence based solutions to common worksite wellness challenges.

Investment analyst and financial journalist Liz Peek has pointed to Partnership for Prevention and its "Leading by Example" initiative as an example of how corporations can "pitch in with gusto to solve America's big problems."

"... Corporations should start providing answers to our country's healthcare crisis," Peek said in a July 22 column entitled "Memo to Corporate America: Wake Up!"

"Companies like Caterpillar and Deere are part of an initiative called Partnership for Prevention, which works to promote employee wellness," she wrote. "These efforts are smart, produce excellent public relations, strong employee ties and simultaneously support the bottom line."

Workers who quit smoking, lose weight, and eat right could have their health insurance premiums cut by as much as half, possibly saving them thousands of dollars per year, under a measure inserted with little notice this week into the Senate healthcare overhaul bill.

Under existing federal law, companies that offer group health insurance can offer a maximum 20 percent discount to employees who can show they have taken steps to improve their health. The new measure would raise that discount to 30 percent and enable the Obama administration to raise it to 50 percent.

The measure could have the most impact at larger companies that are self-insured or provide insurance through a private company, and would likely have less impact at small businesses or those with limited health plans, analysts said.

A public insurance option in health reform legislation could lead some companies to drop employer-based insurance coverage and associated wellness plans, Reuters' Ellen Wulfhorst reports.

"Certainly there are employers now that don't offer healthcare benefits, and if there's a public plan in place, undoubtedly that number will go up," said Lewis Maltby, president of the National Workrights Institute, an advocacy group for human rights in the workplace. "Some employers will certainly say, 'I'm out of here. Use the government plan.'"

About two-thirds of large U.S. companies offer some sort of wellness program to lower the health insurance costs, combat absenteeism and boost productivity.

One incentive under consideration would give tax credits to companies for wellness programs. A Senate proposal would also set aside funds for the Centers for Disease Control and Prevention to serve as a resource for companies to help them establish and standardize wellness program practices.

The Wall Street Journal's Anna Wilde Mathews profiles an initiative by AmeriGas Propane, which requires all employees would to get physical exams preventive screenings. Workers and covered spouses have a year to complete the tests, which are covered 100%, or lose their insurance.

"AmeriGas, based in Valley Forge, Pa., is one of just a handful of companies that have mandated health testing, but benefits consultants say it is at the cutting edge of a growing trend," Mathews writes. "In a February survey by consulting firm Towers, Perrin, Forster & Crosby Inc. 45% of companies said they planned to, or were considering, adding penalties for employees who didn’t participate in wellness activities."

Wellness requirements pose legal questions and raise objections from labor officials. But Mathews notes that, prior to its mandatory program, AmeriGas was facing annual health-expense increases of 10% or more, while its workers had high rates of diabetes and heart disease and only 6% of the enrollees in their health plan had gotten recommended cholesterol checks in the previous 18 months and just 20% had their blood sugar tested.