Citibank is a global financial services company with 130,000 employees worldwide and 51,000 in the U.S. The strategic goals of the Health Management Program (HMP) are to optimize employee health and productivity, reduce or stabilize costs associated with employee illness and injury and contribute to Citibank’s efforts to be the employer of choice.
Since 1994, Citibank’s Corporate Health Services department implemented health promotion programs and services targeted to U.S. employees and Expatriate Staff. Staffed with Master’s level professionals, Nurses, Physicians combined with strategic vendors, the program included health awareness, behavior change, risk and demand reduction components, five on-site medical clinics and an extensive travel health program.
Narrative Description of Program
Citibank is a global financial services company with 130,000 employees worldwide and 51,000 in the U.S. The strategic goals of the Health Management Program (HMP) are to optimize employee health and productivity, reduce or stabilize costs associated with employee illness and injury and contribute to Citibank's efforts to be the employer of choice.
Since 1994, Citibank's Corporate Health Services department implemented health promotion programs and services targeted to U.S. employees and Expatriate Staff. Staffed with Master's level professionals, Nurses, Physicians combined with strategic vendors, the program included health awareness, behavior change, risk and demand reduction components, five on-site medical clinics and an extensive travel health program.
The major component, the Healthtrac Program (health risk appraisal/high risk intervention program) was funded on the corporate level as well as quarterly health education campaigns reaching nearly 80% of U.S. employees. Local businesses also funded site-specific health and safety initiatives and 11 on-site staffed fitness centers.
The Healthtrac program included a HRA, with all participants receiving health status and self-care materials. Approximately 20% "high-risk" participants were offered more intensive targeted follow up programs designed to improve health practices and behaviors, better manage chronic medical conditions, and reduce the demand and need for inappropriate health services. All outreach locations helped promote Healthtrac through displays, staff meetings and health fairs. Using site-specific aggregate Healthtrac data, Wellness coordinators at these locations then collaborated with on-site medical clinics, the fitness center, the Employee Assistance Program, HMO's and healthcare insurers to deliver programs targeted to site-specific needs.
With a financial return of 4.5:1, and now documented health status improvement in 8 of 10 risk areas, efforts are underway to convince the newly merged businesses under Citigroup's umbrella that Health Management Programs make sense for employees, the workplace and the bottom line.
|Program Name||Citibank Healht Management Program|
|Company Name and Address||Citigroup399 Park Ave A/11New York, NY 10043|
|Contact Person||Anita Shaughnessy
|Program Category||Chronic DiseaseHigh RiskWorksite-based|
|Total number of individual participants||36,368|
|Number of currently actively enrolled||11,343|
|Access to Program||Employees at risk for diseaseEmployees with chronic disease conditions|
|Program targeted at Healthy People 2000 and/or Healthy People 2001 goals||Yes - 3/4|
|Program goals (in priority order)||(1)Improve health practice(2) Better manage chronic medical conditions(3) Reduce the demand for unnecessary and inappropriate health services
(4) Increase quality and years of healthy life
Since 1994, the Healthtrac Program was a key component of Citibank's Health Management Program. Citibank's program was a low cost disease/demand management program designed to lower health related risks / costs for high risk participants, and educate lower risk participants about their health to prevent further declines in their health risk profile.
Previously, a large-scale external evaluation conducted by The MEDSTAT Group, Inc. documented a financial return on investment of 4.5:1.0 for the program, with savings attributed to lower medical expenditures for participants compared to non-participants.
Additional follow-up studies have now documented overall health improvement and risk reduction for all employees who participated in any program aspect, and even greater reductions in health risks for employees participating in more intensive high risk programs.
The Healthtrac Program consisted of a series of health risk appraisals distributed on a voluntary basis to employees from whom self-reported health status data were acquired, stored and algorithmically classified to determine which participants were likely to incur high medical costs in subsequent years. Those identified as higher-risk were invited to participate in a more intensive, serial intervention program. Repeat participants from prior programs also received comparative information to track health status over time.
The second research study focused on the program's ability to modify population risk in the following 10 risk factor areas:
- Dietary fiber
- Fat consumption
- Salt intake
- Diastolic blood pressure
- total Cholesterol
- Seatbelt use
- Cigarette smoking
An evaluation study examined employees' self-reported information on the HRA at baseline and approximately three years thereafter. Healthtrac's HRA is based upon the Health Assessment Questionnaire developed by the Centers for Disease Control in 1980 and is generally considered to be valid and reliable in other studies.
Three databases were integrated in evaluation: Healthtrac's high-risk participant data, risk data recorded from the multiple HRA forms and Citibank's health plan enrollment data.
The first analysis compared a pretest/posttest cohort group with multiple HRA's to evaluate health risk reduction over time. The second analysis used a quasi-experimental research design and compared those high- risk participants enrolled in interventions and non-participants with similar health risks. Where possible, criteria for high-risk assignment came from previous research from the Health Enhancement Research Organization (HERO). Healthtrac staff also helped develop markers for high-risk categories not included in the HERO study. Program effectiveness was determined if the proportion of high-risk employees was significantly lower at the second HRA when compared with baseline.
- Data analysis revealed statistically significant improvements in 8 of 10 risk categories (organized in greatest to least change over time) which included seatbelt use, exercise, stress, fiber intake, fat and salt consumption, smoking, and diastolic blood pressure.
- For the most part, risk declines tended to be greater when the time period between HRA's was shorter.
- Results support other research findings that more intensive, personalized health management programs achieve better health outcomes than more general awareness building campaigns.
Combined with a 4.5:1.0 ROI financial return reported earlier, this evaluation also documents improvements in health risks and helps further support goals endorsed by The U.S. Department of Health and Human Services: Healthy People 2010.
This long-standing program, evolved for the Citigroup environment, was found to support Healthy People 2010 goals, have good participation rates, and be well documented. Reviewers praised the intensive statistical analysis and the different techniques employed to ensure data integrity. There was documented strength in reducing health risks in 8 of 10 categories and a detailed report of intervention and monitoring program for the high-risk population. It was a well designed evaluation effort with a wide range of program offerings. Another plus was the data analysis by outside experts! Analyses were published in peer-reviewed journals. This is perhaps the Koop program with the best overall results; an ROI of 6:1.
Several reviewers said that determinations had been based upon self-reported data but that they were well validated.
Reviewers thought this program had extremely well designed components and analyses with well-documented improvements in health status and favorable financial returns.