C. EVERETT KOOP NATIONAL HEALTH AWARDS

Pitney Bowes Health Care University

Evaluation Summary

Highlights of Program Results

Significant investment in integrated data systems and analysis enables Pitney Bowes to target resources, and monitor progress effectively. The analysis:

Uses on-line, individual-level data including three years of medical claim, enrollment, and disability experience
Uses a total episode of care approach to measure provider performance and health status improvement
Is involved in the creation of a predictive model to identify at-risk individuals at an earlier stage.

To evaluate program results, a longitudinal study was performed of the impact of HCU on participants and non-participants. Health care cost data was integrated with information about HCU program participation. Statistical methods were used to control for differences in the participant and non-participant groups relating to age, sex, and geographic price differences. Participation was measured in several ways: for any HCU program, for all HCU, and programs such as cardiovascular health, psychosocial functioning, etc.

Results - HCU

Participation in the HCU program is approximately one-third of eligible employees. Data analysis shows that HCU participants had significantly less growth in health care costs over time than non-participants. After controlling for age, sex, and geographical cost differences, HCU participants had significantly lower covered expenses than non-participants. In 1995, actual covered expenses were seven percent higher in the non-participant group: $2,317 compared to $2,173. Even more important, the trend for participants showed an actual decrease of five percent over the three years of the study. Non-participants showed a two percent increase in costs. This analysis yielded a 2.8 to 1 cost savings for HCU.

Self Care Program

The self care program uses the Take Care of Yourself guide to self care with an educational session. Data analysis shows that Self Care participants had significantly lower levels of emergency room utilization compared to non-participants. Participants averaged less then 0.1 emergency visits per year, while non-participants averaged over 0.2 visits. Based on this analysis, the Self Care program yielded a three to one savings.

Self Care participants maintained the same number of planned professional visits as non-participants, indicating that the level of access to appropriate primary care was being achieved.

Fitness Center

Pre- and post-participation comparison of on-site fitness center members showed that they have:

Fewer sick days (47 percent less)
Reduced smoking prevalence (10 percent reduction)
Better fitness status (20 percent of participants improved)

In addition, 20 percent of participants report improved nutritional habits and 50 percent report increased work productivity.

Ergonomics

The Corporate Ergonomics Management Group demonstrated a 5:1 ROI ratio and net savings of $2.1 million through accident avoidance, reduced workers compensation and increased productivity. This program used ergonomic review, education, and reconfiguration of workspace to achieve better safety and efficiency. Program expenses of $545,470 were offset by savings of:

$834,219 for increased efficiency, reduction of work space
$1,869,911 from avoidance of major injuries

In addition to the above figures, savings from ergonomics are reflected in the $700,000 reduction in Workers' Compensation insurance claims for 1995 and in the reduction in Pitney Bowes insurance experience modifier. Communication and trust between management and employees have also improved since the program's inception.

Disease Management - Asthma

The Asthma monitoring program was piloted in September of 1995 and focuses on education regarding self-management and routine at the worksite. The first step in this process was a mail survey sent to 5,000 employees with a cash incentive for completion. Candidates were identified based on severity, health resource use, and desire to participate. Six-month results show:

Peak flow values improved by 13 percent
Quality of life scores significantly improved
Emergency room and unplanned doctor visits were reduced
Self-reported productivity improved

Planned doctor visits increased during the study period, indicating better compliance, access to appropriate care, and symptom control versus acute episode occurrence.

Future Study Direction

Pitney Bowes plans to continue integrated analysis of its health management initiatives which will allow Pitney Bowes to make fact-based decisions regarding program evolution and development. Additional data sources under consideration include satisfaction, expanded health status and quality of life measures. Wherever possible, Pitney Bowes will strive to incorporate recognized, standardized measures to facilitate comparison to national and regional normative data.

A pilot Health Risk appraisal that was administered in one location will be offered to all employees in the near future. Data will be used to assist with targeting preventive care initiatives. In addition, disease state management offerings will be expanded: programs addressing depression in the workplace, diabetes, and migraines are being phased in this year. Data gathered from these programs will be integrated for analysis of impact and outcomes.

HCU Evaluation Methodology and Data Analysis Findings

The evaluation of the effectiveness of Pitney Bowes' HCU focused on two questions:

1. Did participants in HCU have significantly lower health care costs than non-participants?
2. Did participants use health care services more appropriately?

These questions were tested using a pre- and post- comparison group design. The pre (or baseline) period was July 1992 - June 1993. The post (or implementation) period extended from July 1993 - December 1995.

Multivariate statistical techniques controlled for differences in the participant and non-participant groups. Differences that were controlled for included age, sex, health plan coverage, and regional price differences.

The health care cost measures that were analyzed included:

Total covered charges:

Covered charges related to circulatory disorders
Covered charges related to mental health/chemical dependency
Covered charges for non-emergency professional services
Covered charges for emergency room services

The utilization measures studied were:

Non-emergency professional services
Emergency room services