Aetna, Inc. is a premier provider of health and financial services with 33,000 employees and 13,000 retirees located nationwide. Aenhance, Aetna’s employee wellness program, is part of the employee benefits plan and a partner within a total health management strategy. Aenhance strives to strengthen synergy between preventive health services available at the workplace, through the health plan and within the community. Program initiatives are designed to compliment health plan benefits and fully leverage, rather than duplicate, plan offerings.
Narrative Description of Program
Aetna, Inc. is a premier provider of health and financial services with 33,000 employees and 13,000 retirees located nationwide. Aenhance, Aetna's employee wellness program, is part of the employee benefits plan and a partner within a total health management strategy. Aenhance strives to strengthen synergy between preventive health services available at the workplace, through the health plan and within the community. Program initiatives are designed to compliment health plan benefits and fully leverage, rather than duplicate, plan offerings.
Program goals are to:
- Promote positive health behaviors for optimal health and productivity,
- Help minimize Aetna's medical liabilities due to injury and illness.
- Promote appropriate utilization of the healthcare system.
- Support a healthy worksite culture that enables employees to contribute their best.
- Enhance employee commitment and satisfaction with Aetna as an "employer of choice."
The scope of Aenhance programs includes prevention, early intervention, healthcare consumer education, return-to-work, and community health advocacy programs. In addition, Aenhance manages two full-service fitness facilities in Connecticut home office locations.
The nature of health interventions include awareness, assessment and screening, behavior change (via on-site group education, self-directed programs, intranet delivery and telephonic coaching and decision support service) and environmental support programs and policies. Primary program components include medical self-care, smoking cessation, back health, nutrition, fitness, cancer prevention, women's health, maternity management, breastfeeding support and on-site physical therapy.
In 1995 Aetna, Inc. initiated a multi-dimensional healthcare consumer education strategy to help manage Aetna's medical care costs and promote appropriate use of the healthcare system. As part of the strategy, Aetna U.S. Healthcare's Informed Health Line (IHL) program was incorporated as an add-on service to the Aetna benefits package for all employees and retirees.
IHL provides access to a toll-free, 24-hour telephone line staffed by experienced nurses. The nurses offer health information and decision support but do not diagnose, prescribe treatment or give medical advice. The program also includes an introductory kit mailed to the home, which provides an Informed Health Handbook. In addition to the IHL service, a comprehensive communication and education strategy was initiated through Aenhance to increase awareness about the program and help improve medical consumer behaviors. The strategy includes on-site workshops, awareness campaigns, self-directed programs and ongoing communications via interoffice mail, e-mail, internal newsletters, showcase displays and postcard mailings.
Program eligibility: All Aetna employees, spouses, domestic partners, dependants ( 18 and older) and retirees are eligible to participate in Aenhance programs.
Staffing and Budget. 3.6 FTE wellness professionals, 10.9 FTE exercise physiologists, 5.6 support staff. Wellness Budget = $535,000 ($ 1.35 PEPM) fully subsidized by Aetna as part of the employee benefits plan. Fitness center budget = $2.7MM. Aetna subsidizes 65 percent of costs and 35 percent are recovered through membership fees.
|Program Name||Aenhance Program|
|Company Name and Address||Aetna, Inc.151 Farmington Ave.Hartford, CT 06156|
|Contact Person||Barbara Pelletier, M.S., R.D.
Manager, Employee Wellness Program
|Program Category||Integrated Systems of Care|
|Total number of individual participants||not available|
|Number of currently actively enrolled||23,990|
|Access to Program||Employees, retirees, spouses, dependents. domestic partners|
|Program targeted at Healthy People 2000 goals
|Program goals (in priority order)||(1) Promote positive health behavior(2) Minimize medical liability due to injury and illness(3) Promote appropriate use of healthcare system(4) Support healthy worksite culture|
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.
This is a broad, well funded program with data showing marked effectiveness. Strengths are the integrated approach, comprehensive programming and evaluation, improved health, behavior change, and cost-effectiveness. A great strength is the variety of health improvement and preventive health services including consumer education, self help, the lactation program, fitness complements, and more. It is obvious that a great deal of creative energy, manpower, and money were spent in developing the plethora of opportunities that are described
Reviewer concerns were that there was not the ability to exclude self-selection bias even in these well done pre-post comparisons. There are no "intention to treat" results. Cost data were only available for 345 out of 5500 employees participating in the fitness program, making extrapolation to the total population a bit of the uncertain. Follow-ups for the survey were quite low. In contrast, there is excellent documentation on the fitness cost-effectiveness study although it could have benefited from more complete statistical analysis.