A Modifiable Claims Audit (MCA) evaluated 1992 health care claims to establish benchmark levels of lifestyle and behavior-related costs. The results showed that nearly 17% of Northeast Utilities (NU) 1992 health care claims were attributed to modifiable, lifestyle behaviors. Based upon established best of class health enhancement programs as well as the MCA findings, the WellAware program was designed. Annual refinements, are considered, evaluated and implemented.
To improve the health and well-being of employees and families through participation in targeted programs and services that address lifestyle related health risks and to reduce health care costs.
A Modifiable Claims Audit (MCA) evaluated 1992 health care claims to establish benchmark levels of lifestyle and behavior-related costs. The results showed that nearly 17% of Northeast Utilities (NU) 1992 health care claims were attributed to modifiable, lifestyle behaviors. Based upon established best of class health enhancement programs as well as the MCA findings, the WellAware program was designed. Annual refinements, are considered, evaluated and implemented. The key features of the program are:
- financial incentives for participation
- employees and spouses are eligible
- strong senior management support
- ongoing evaluation and re-design
The components of the program include:
- Health Risk Assessment as the "ticket" into the program; available in paper or online
- Incentive program drives participation in programs/services that address targeted risks
- Telephonic high risk intervention
- Secondary coronary artery disease (CAD) management program
- Telephonic smoking cessation counseling and rebate for purchasing smoking cessation aids
- Integration with internal departments (Health Units, Safety, EAP) and external partners (health plans, local hospitals, etc.)
- Flexible program formats allow accessibility to all employees and spouses via on-site programs, communication of community programs, guidebooks, videos and telephonic intervention programs
- Quarterly health newsletter mailed to all homes
- Internet site allows access at both work and home
- Toll free hotline allows participants to request materials, ask questions
|Company Name and Address||WellAware6 Corporate Dr., 4th FloorSuite 444
Shelton, CT 06484
|Contact Person||Tom Sabia|
|Program Category||Chronic DiseaseWorksite BasedHigh Risk
|Total number of individual participants||10,000+|
|Number of currently actively enrolled||5,000+|
|Access to Program||All NU employees and their spouses (N=15,000)Program targeted at Healthy People 2000 and/or Healthy People 2001 goals|
|Program goals (in priority order)||(1) Improve the health and well-being of employees and families(2) Reduce health care costs(3) Establish partnership between employee/employer for health
(4) Deliver targeted lifestyle-related program/service
A. Reduced Medical Claims
1992 health benefit claims were evaluated to establish benchmark levels of lifestyle and behavioral related costs for NU's population. As a result, WellAware was conceived and implemented during 1994. After 24 months, 1996 claims were analyzed to determine if the WellAware program was producing positive financial results and predict future financial performance. NU experienced flat per capita costs for health care and a $1,400,000 reduction in lifestyle and behavioral claims. Conservatively, the return on investment for the WellAware program, in it's first 24 months, was 1.6. Future expectations for WellAware's impact on reducing claims grows greater with time.
B. Reduced Health Risks
StayWell's HealthPath Health Risk Assessment (HRA)1, which identifies participant's health risks, is the first step to participating in the WellAware program. The association between higher health risks and increased direct medical costs has been shown in studies at Daimler Chrysler2 and most recently demonstrated by Goetzel, et al.3
2,577 participants completed a second HRA between 1998-2000. These participant's average lifestyle score improved to 73 compared to 70 at baseline. Individuals also experienced significant reductions in risks, including a:
- 31% decrease in smoking
- 29% decrease in lack of exercise
- 16% decrease in mental health risk
- 11% decrease in cholesterol risk
- 10% improvement in eating habits
- 5% decrease in stress
Research has found that employees with multiple risk factors for heart disease, stroke and psychosocial problems, incurred much higher average annual medical expenditures than did their low-risk co-workers.2
The percentage of the 2,577 repeat HRA participants with multiple risk factors improved. Participants with:
- less than three risk factors increased 6%
- less than two risk factors increased 9%
- six or more risk factors decreased 4%
StayWell estimates that these changes have resulted in an annual savings to NU of $1,087,900.
C. Targeted Intervention Outcomes
Participants who complete an HRA and are determined to be at high risk in two or more health areas, were invited to participate in a telephone-based intervention program. The long-term impacts of this intervention model were evaluated in a study by Gold, et al,4 who found that participants in a phone based intervention program were 1) more likely to reduce their risks, than were non-participants, and 2) more likely to reduce their risks in other areas not specifically targeted by the intervention. The NU participants who participated in the phone intervention reduced their risk status in all areas, while those who chose not to participate, showed an increase in risk levels.
D. Cost Savings For Individuals With Coronary Artery Disease
Northeast Utilities 1996 health care claims found that the company experienced total medical costs of $1,377,000 for coronary artery disease (CAD) related claims. 57 CAD-related hospitalizations resulted in disability plus related inpatient and outpatient costs averaging $46,582 per hospitalization.
Telephone counseling 5,6 and low cost educational tools7, have been shown to be effective interventions for disease management. After the implementation of a successful one year pilot group, a CAD intervention, (consisting of telephone counseling and support materials), was made available to all eligible individuals with diagnosed heart disease. Based on previous NU claims experience, the CAD intervention has demonstrated a 72% reduction in all CAD events and a 77% reduction in major CAD events.
Improvements in clinical outcomes have also been demonstrated as has high level participant satisfaction.
Gross savings were determined by calculating the 12 month anticipated rate of re-hospitalizations versus the actual re-hospitalization rate of NU participants for the 12 month time frame.
A return on investment of 2.6 in reduced medical claims and disability has been demonstrated.
E. Smoking Cessation
A smoking cessation intervention was designed based on experts recommendations for combining behavior modification with the option for drug therapy. No cost, telephonic counseling was combined with a rebate of $100 for the purchases of approved smoking cessation aids, (Nicotine Patch, Nicotine Inhaler, Zyban, etc.). The 12 month results of this combined intervention resulted in a 44 percent quit rate, with another 12 percent of participants still enrolled in the program and planning to quit. These results far exceed national statistics showing that typical smoking cessation programs achieve a 20 to 30 percent quit rate at six months.13
1 Reliability and Validity of StayWell's HealthPath Health Risk Assessment
The validity and reliability of StayWell's HRA technology has been developed and tested over a 20 year period and has been subjected to rigorous validation testing.
Content validity has been assured through a two-step process. Subject matter experts were con- sulted to identify and prioritize content domains to be included, to identify standard and often previously validated measurement protocols and develop initial questions for testing as necessary. Second, large groups of test participants were asked to complete and evaluate the questionnaire. Subsequent use of the assessment tools by several million participants had provided further verifi- cation of exceptional content validity.
Predictive validity of the assessment tools on key indicators such as mortality, medical costs and absenteeism has been validated by several landmark studies. StayWell's 1987 study linking health risk assessment questions to medical costs, "Health Risks and Behavior: The Impact on Medical Costs," conducted jointly with the actuarial firm of Milliman and Robertson, Inc., has been acclaimed as a milestone in the health promotion field. A 1995 study conducted by the same parties, replicated these earlier results.
The American Institutes of Research, Cambridge Research Center, validated mortality predications made by 40 HRA's against cases selected from the Framingham Study that has know mortality out comes. The validity of the StayWell HRA, was comparable to the best health risk assessments available in the study.
Reliability of the HRA was reviewed concordance between baseline and follow-up risk levels across both self-reported and screening risk measures. For 2 week intervals of test-retest reliability assessment, concordance levels generally approached 100% for most assessed risk areas.
StayWell Impact Model
The StayWell Impact Model (SIM) is a proprietary analysis tool that estimates avoidable health care costs based on demographic and health risk data collected by the HRA. SIM projects current avoid able costs related to current participant health risks. The health risks represent significant avoid able health care costs and include, smoking, lack of exercise, weight control, back care, driving, blood pressure, cholesterol, mental health, stress, and alcohol use.
SIM was developed based primarily on the results of a series of studies, the first of which was a landmark study: Health Risks and Behavior: The Impact on Medical Costs, 1987. The most recent research supporting SIM is the HERO study, conducted by StayWell and the MEDSTAT Group and sponsored by the Health Enhancement Research Organization.
2 Impact of the StayWell Program on Chrysler Health Care Costs, Zwanziger, J., Davis, C., 1999
3 The Relationship Between Modifiable Health Risks and Health Care Expenditures: An Analysis of the Multi-Employer HERO Health Risks and Cost Database. Goetzel, R., et al, American Journal of Health Promotion, Vol. 15, Number 1, Sept./Oct. 2000, pp. 45 - 52
4 Impact of a Telephone-based Intervention on the Reduction of Health Risks, Gold, D., Anderson, D., Serxner, S, The Science of Health Promotion, Volume 15, Number 2, November/December, 2000, pp. 97- 106
5 The Utility of the Telephone in Disease Management. Wasson, Gaudette, Whaley, et al, Journal of American Medical Association, 1992; 267: 1788
6 Congestive Heart Failure Cases Respond Favorably to Telephone Management System, American Journal of Cardiology, 1997: 79: 58 - 63
7 Low-Cost Patient Education Interventions as a Disease Self-Management Tool, StayWell/Krames, Congestive Heart Failure, May/June, 1998
8 Official Disability Guidelines, Work-Loss Data Institute, 2000
9 Business and Health: Special Report, What Cigarettes Are Doing to American Business, 1997
10 Occupational Risks Associated with Cigarette Smoking: A Prospective Study, Ryan, J., et al, American Journal of Health Promotion, June, 1992, pp. 29 - 32
11 Health and Economic Implications of a Work-Site Smoking Cessation Program: A Simulation Analysis, Journal of Occupational and Environmental Medicine, Oct. 1996, pp. 981-990.
12 Making Your Workplace Smoke-free: A Decision Maker's Guide, Centers for Disease Control, 1991
13 Surgeon General's Report on Smoking, 2000
Four salient factors in this program that particularly caught the attention of the reviewers were the exceptional smoking quit rates (44%), the number of participants (including spouses), the overall accessibility of the program (on-line, onsite, telephonic, take-home materials), and the comprehensive risk reduction program. The use of financial incentives was lauded.
Although overall results were impressive, reviewers wondered why they had not been externally reviewed. Cost savings estimates were based on Staywell risk factor/cost reduction extrapolations versus actual data and claims impact was estimated based on risk reduction rather than that of actual claims. Reviewers would also have liked to see more information on the incentive programs.
This program was generally thought of as very strong and successful with a broad range of focused programs, significant cost reductions, and evidence of health improvement across programs.