C. EVERETT KOOP NATIONAL HEALTH AWARDS

Aetna, Inc. Evaluation Summary

Evaluation is continuous process and an integral part of the Aenhance program design. Data is measured to continuously assess and monitor:

Program utilization including total participation as well as program reach to home office vs. field locations.

Health behavior change including actual and self-reported measures based on self-efficacy and participant tracking records.

Impact on wellness as related to physical, psychological and work-related health factors.

Cost savings, when possible, to measure direct and indirect medical costs and return on investment.

Customer satisfaction and value of services as part of the employee benefits plan.

Aenhance is part of an integrated health management strategy in which several individual program components have demonstrated positive outcomes. These studies and findings will be further described in the documentation to follow. Highlights include: Aetna, Inc.'s health care consumer education strategy initiated in 1995 was evaluated using a pre- and post-test study design. A one-year follow up survey of a statistically random sample of Aetna employees (N= 15,000) and retirees (N= 2,000) suggests that the initiative has significantly enhanced medical consumer behaviors. Respondents' increased self-efficacy for using the Informed Health Handbook as well as preparing for an office visit and communicating with the doctor (P value < .01). The first action taken at the sign of a health problem also changed significantly for survey respondents. In the pre-test, "Calling the doctor" was ranked as the first action taken. In the post-test, "Using the home self-care book" was ranked as the first action taken, increasing 71 percent over pre-test scores.

Aetna's corporate lactation program initiated in 1996 has helped support a smooth transition for women returning to work following a maternity leave. To date, 203 participants have "exited" the program with 53 percent breastfeeding for six months or longer (compared to national data of 14 percent for working women). The return on investment is conservatively estimated to be 2.18 to 1.0. The cost model used is based on industry research which has demonstrated reduction in medical cost and time lost from work due to infant illness in the first year following baby's birth.

Several fitness program studies have demonstrated positive outcomes related to both health and work-related benefits:

A nation wide fitness program. Get Active Aetna, was evaluated using a pre- and post-test study design. Follow up evaluation data from a statistically random sample (N= 1,160) of program participants suggests the program was highly successful for attracting inactive employees and motivating them to begin an exercise program. Pre/post data suggests the number of inactive participants decreased by 57 percent and the number of participants exercising three or more times per week increased by 28 percent.

A fitness impact survey of a statistically random sample (N= 1,046) of fitness center members gained both health and work-related benefits. In addition to improving health and fitness status, respondents reported gains in ability to manage stress, balance worksite issues, keep a positive outlook and maintain attentiveness at work. Chi Squared Automated Interactive Detection (CHAID) analysis suggests a strong statistical link exists between participation in the fitness program and employee productivity.

A cost effectiveness study was conducted over a 24-month period to compare medical costs of fitness center participants (N= 345) compared to a control group of non-participants (N= 2,015). Total medical claim costs of employees were reviewed and analyzed using SAS GLM (General Linear Models). Total medical costs for fitness center participants declined compared to a significant rise for non-participants following 12 months of fitness center participation. In addition, number of hospital admissions, cost per hospital admission and average (hospital) length of stay for fitness center participants also declined compared to non-participants during this time frame. These findings show a difference of $282 in medical costs per fitness participant (compared to non-participants) in the year after joining the fitness center. Extrapolation of these findings to the entire fitness center population of 5,500 members would result in savings of $1.55 million annually.

Data is available for external review for some programs.