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Program Evaluation Summary

2004 Koop Award Winner

UAW-GM LifeSteps Health Promotion Program

Narrative Description of Evaluation Results

II. Evaluation Summary

LifeSteps was introduced in the summer of 1996 as a health and behavior management program designed to improve and maintain the health of the overall population of General Motors Corporation.

•   The three major outcome measures that test the effectiveness of the LifeSteps program in making a difference at GM are participation, health status and medical costs.

The overall participation including self-reported participation in nontrackable programs was 78%.  Active employees with intensive programming had 77% documented participation. Risk reduction for those employees shows the most net migration to low-risk (13.4%) among measured groups. Savings-to-cost ratios for employees ranged from 2.1 in intensive programs to 3.7 in the U.S-wide program.  The savings-to-cost ratio for the total eligible population was 1.2.

Evaluation protocols

The University of Michigan Health Management Research Center evaluated the health and economic impact of the program.  Prior to program implementation, the UM-HMRC selected 3% and 10% samples, tested the reliability and validity of the LifeSteps Health Risk Appraisal (HRA), and determined the outcome measures for the success of the program. The evaluation used a longitudinal pre- and post-test quasi-experimental protocol.

The evaluation system integrated data from each individual, including nine years of medical claims, measured biometrics, disability absence records, telephonic counseling, and wellness program participation. Health perception and risk prevalence were collected from HRAs. 

Descriptive and multivariate analyses were used to assess the program impact on health risk change among repeat HRA participants. Using both multiple regression and trend analysis, the financial impact of the program was assessed by changes in medical claims and absence days associated with program participation.

The evaluation of the LifeSteps program contributed to worksite health in two ways: 1) eighteen publications provided important scientific contribution to the progressive knowledge in the field; and, 2) numerous technical reports provided data-driven decision support for the UAW-GM efforts to enhance health and quality of life for over 1 million Americans.

The evaluation team for the LifeSteps project at the UM-HMRC is under the leadership of D. W. Edington. There are eight Ph.D.s, in a variety of fields, and eight with all but dissertation status.  The remaining people have Masters degrees for a combined average of 15 years experience in this field. 

Highlighted Results

1 Participation

  • Documented by Individuals: 356,833 (34%)
  • Documented by Households:  264,834 (43%)
  • Documented plus Untrackable by Individuals: 800,000 (78%)

2 Risk Status

  • Risks Identified: 815,298
  • Risks Reduced: 185,550
  • Increase in Low Risk Status - Active Onsite:  13.4% increase
    • Risk with the Highest Risk Reduction 
      • Safety Belt Use:  50.6%
      • Blood Pressure:  28.7%
      • Life Satisfaction: 21.1%
      • Stress: 20.9%

3 Savings

  • Medical Savings over Four Years: $97/participant  (Indemnity/PPO plans)
  • Disability/Absence: $240/participant/year

4   Medical Savings to Cost Ratios After Four Years

  • For All Participants: 1.2
  • For Active and Retired Employees: Ranges from 2.1 to 3.7
  • By Selected Program: Ranges from 4.8 to 14.3

5    Contributions to Scientific Knowledge (18 peer-reviewed articles)

  • Use/promotion of preventive services in the maintenance of health
  • Program delivery for those above 65 years of age
  • Development of cost-based individual score and organizational score assessing health status
  • Natural flow of health risks and health care costs 
  • Co-morbidity of health risk combinations and risk clusters and associations
  • Risk transitions between high, medium, and low-risk status related to program impact 
  • Excess Cost – Risk Cost
  • Prediction models
    • .           Diabetes onset
    • .           Mental health

Going Forward

After extensive medical and financial reviews by the UAW and General Motors management, information contained herein were used to design the program going forward to include

  • Expansion of the intensive program components from the pilot locations to include all 167,000 hourly and salaried active employees
  • Maintain program components serving all other target populations