Quest Diagnostics

Health of the individual and population is assessed using a variety of methods including: a 60- item health risk assessment, emotional well-being screening, biometric screenings, comprehensive lab testing, colorectal and prostate cancer screenings, employee surveys, claims data (medical, pharmacy, behavioral health, disability), monitoring devices (cellular scales and glucometers). Biometric screenings are provided onsite in 93 events across 45 locations and near-site at our 2,250 patient service centers.

A physician network is available to all screening participants via teleconference technologies to discuss screening results and guide referral and follow-up. Health / disease management and behavior change programs are made accessible through a variety of modalities including phone, email, web, in-person, group classes, and social connections and are offered through the both the health plan (Aetna Advocate team) and health program through Quest Diagnostic services (including free lab work, chronic kidney disease identification, and colorectal cancer screening and referral).

Based on early insights revealing the need to engage employees with greater health opportunities (higher health risk / lower health engagement), Quest Diagnostics strategically identified promising vendors to supplement their care pathways. Currently, they partner with a variety of vendors to offer a health program that consists of more than 15 components to meet the targeted and specific needs of each individual member. Programs support the physical, emotional, and social needs of the individual. Programs range from diabetes prevention and weight management offered through Omada Health, mental health screening, support and connections to care offered in partnership with Johns Hopkins, onsite health coaching offered through Active Health, financial well-being offered through Fidelity. In addition, they have produced interactive educational modules to help employees acquire the knowledge they need to achieve and maintain positive health behaviors. Leading indicators of health program components are evaluated monthly to enable timely and efficient improvements.

Maren S. Fragala, PhD

508.728.2923

Maren.S.Fragala@QuestDiagnostics.com

Evaluation Objectives:

• Rising healthcare costs challenged Quest Diagnostics to fine-tune their population health strategy with the goal of long-term sustainability by implementing the Institute for Healthcare Improvement’s “Triple Aim” strategy to (1) improve the experience of care, (2) improve the health of populations, and (3) reduce per capita costs of health care.

Approach and Methodology:

• Developed HealthyQuest based on baseline HERO scorecard assessment to enrich their culture of health, support making healthy the easy choice and foster the creation of an inspiring workplace.
• Built-out their care pathways with targeted interventions for participants of our world-class Blueprint for Wellness health-screening program to provide complimentary physician sessions and health improvement program opportunities to deliver higher value; partnered with industry leaders to implement novel population-health solutions.
• Introduced a cutting-edge approach to proactive mental health in partnership with medical academic leader, Johns Hopkins. Focused health improvement components are all integrated into our overall organizational culture that promotes health and well-being.
• Utilized a variety of data sources to determine outcomes including laboratory and biometric data of 47 tests and biometrics obtained in annual health screening, health risk assessments, program specific data included engagement and weight loss, Active Health indices, and medical and pharmacy claims. Data sources were combined in a data warehouse following privacy protective and HIPPA compliant methodologies for analysis of limited datasets. Analyses were conducted on the large population, program participants, and specific cohorts.

Sampling of Evaluation Results:

• Health behavior improvements included increased physical activity, sustained weight management, and reduced risk for diabetes and cardiovascular disease.
• HERO Scorecard results improved 50-points between 2016 and 2020, with current 2020 score being on par with national high performers.
• Saved an estimated $40M over 4 years in healthcare costs, achieved measurable improvements in health (reduced diabetes and cardiovascular risk), and maintained positive member experience (>80% satisfaction).
• Able to keep employee contributions to medical care flat between 2016-18, publish our results for the benefit of other self-insured employers, and develop innovative health solutions for broader populations.

• Quest Diagnostics 2020 Koop Award Application FINAL_Public Release Version

REVIEWER 1

• Senior leadership strategic guidance and articulation of health values
• Multiple channels of solicited employee input and feedback into program
• Comprehensive assessment tools and implementation/triage strategy
• Encompassing physical, emotional, social and financial health
• Investment in environmental/worksite elements and achieving WELL-building standards
• Extensive, strategic encouraging engagement throughout the year
• Strategic approach to health equity and addressing disparities
• Comprehensive, robust programming to support outcome-based incentive tactics
• High levels of participation in many follow-up program elements beyond screenings
• High 182 HERO Scorecard results with 50/50 on organizational/cultural support
• Excellent weight loss and medical cost savings in DPP/METS program in rigorous analysis
• Substantial medical cost savings versus trend over a 4-year period 2016-2019
• Multiple peer-reviewed studies supporting health outcomes results

REVIEWER 2

• Have improved program based on HERO scorecard results.
• Saved an estimated $40M over 4 years in healthcare costs, achieved measurable improvements in health (reduced diabetes and cardiovascular risk), and maintained positive member experience (>80% satisfaction). Kept employee contributions to medical care flat between 2016-18.
• Senior leadership support.
• Employee input actively solicited.
• Wellness champion network.
• Includes emotional, social, and financial well-being.
• Primary-level interventions to create healthy work environment (e.g., WELL building standard).
• Financial incentives.
• Focus on reducing disparities by engaging frontline, lower-wage workers.
• 80% participation.
• 182/200 on HERO scorecard (50-point increase since 2016).
• Use of data warehouse.
• Propensity score matching.
• Use of care pathways for early identification and intervention.
• Use of telehealth services.

REVIEWER 3

• Like that they analyzed sustainability of their program’s performance
• Business outcomes can be tied to departmental performance too which would allow more internal comparisons. Stock price is influenced by too many factors to attribute the health strategy as a driver
• Graph on diabetes prevention is a good representation of impact

REVIEWER 4

• Addresses leadership and role of policy
• Strong data

REVIEWER 5

• Conflict

REVIEWER 6

• Used HERO Scorecard to inform strategy.
• Complimentary physician network to screening participants.
• Mental health partnership with Johns Hopkins
• Senior leadership engaged on steering committee and as members in external thought leadership organizations related to employee health.
• Quest Community Action Network supports healthy communities.
• Holistic model supports physical, mental, emotional, social, financial well-being.
• Certified well building designs pursued for renovations or new construction.
• Addressing social disparities with pilot programs that include social workers on staff.
• Strong employee engagement survey results with 94% participation in survey.
• Very strong improvements over time in HERO Scorecard with exceptional recent score.
• Very strong investment in culture of health and healthy workplaces may positively influence health of uninsured employees.
• Improved health status for insured population attributed to closure in care gaps for many preventable health risks and conditions.
• Early identification and treatment of chronic conditions associated with estimated delay of more severe health conditions.
• Many program-specific evaluations demonstrate significant participation/completion and health improvements.
• Many program-specific evaluations were published in peer-reviewed journals.
• Population-level cost savings compared observed to projected trends after taking plan design into account.
• Stock price increases associated with same timeframe as investments in employee health initiatives.
• Evaluation of diabetes prevention/metabolic syndrome relied on quasi-experimental, differences-in-differences approach with propensity matching but was based on cost modeling approach.

REVIEWER 7

• Triple Aim Strategy
• Comprehensive wellness program focused on physical health metrics and intentional environmental modifications to numerous workplaces for improved health. (WELL Building).
• Favorable financial incentive for medical plan members.
• Utilize Kotter’s model of change to implement “healthy the easy choice”.
• Notable improvements in biometric values to include cholesterol, blood pressure, triglyceride and body weight.
• Successful chronic disease and preventive screening programs/campaigns.
• Notable health care cost reduction over time.
• Interesting correlation of health improvement strategy/program and stock performance.
• Expertise in health improvement/wellness leadership with significant partner involvement.
• CEO support and involvement, including a personal letter with the application.

REVIEWER 8

• Nice program with a lot of options and attention to access and cost.
• Organizational Strategy/ Support: Very good.
• Implementation/Program Participation & Engagement: Very good.
• Health Outcomes: The most impressive data are for screening and case finding, which suggest that even in a very health-conscious company and industry, many people do not get the care they need without aggressive, population-based screening.

REVIEWER 9

• Five years – 47,000 employees
• Good strategic goals and program mix
• Adequately addressed work environment
• Addressed cultural issues within each worksite – impressive
• Comprehensive frequency statistics
• Good evaluation results – able to show trends
• Correlated to stock price – very good
• Good summary of limitations

REVIEWER 10

• Reported improvements/savings estimated $40M over 4 years in healthcare costs, achieved measurable improvements in health (reduced diabetes and cardiovascular risk), and maintained positive member experience (>80% satisfaction).
• Resulting in employee contributions to medical care flat between 2016-18.
• Comprehensive program; ranging from diabetes prevention and weight management offered through Omada Health, mental health screening, support and connections to care offered in partnership with Johns Hopkins, onsite health coaching offered through Active Health, financial well-being offered through Fidelity.
• Demonstrated improvement in 2019 HERO scorecard of 182/200 up from 129 in 2018.  80% of eligible employees participated in programs. Reported modest weight loss (Omada program), reduced rates of metabolic syndrome (27%) as well as participation in CVD/Diabetes intervention reducing fasting glucose, HbA1c, Triglycerides (p=0.013).  Results of claims analysis revealed increases of 10% ($421/person) on average compared to those with similar risk for diabetes who did not participate (increase of 25% ($1,018/person), resulting in a savings of $597/person per year in medical claims compared to non-participant values.

REVIEWER 11

• Overall strategy seems very well conceived and integrated nicely into policies. Program offerings seem to offer a smart combination of assessment, skill building, policy and environmental supports. Efforts to reach remote or hard to reach employees are encouraging.
• Participation rates are excellent.
• Efforts to improve your program through HERO scorecard assessment are encouraging.
• Improvements in preventive screenings, clinical compliance, biometric screening values, physical activity, weight, disease risk are impressive.
• Success in bending the cost curve is impressive, and the methodology to connect this to program participation is reasonable.
• The innovations described are impressive.
• Thank you for providing the key Variable Tables.
• The application was well organized, clearly written and a pleasure to read. Thank you.

REVIEWER 12

• Conflict

REVIEWER 13

• Conflict