UAW-GM

Narrative Description of Program

The UAW-GM LifeSteps Health Promotion Program targets over one million covered lives including all employees, pre-Medicare retirees, Medicare retirees, spouses and adult dependents. The program, unique in breadth and depth, delivers health management programming to this entire population through collaboration with joint UAW and GM leadership and external providers to ensure confidentiality and expertise in program delivery.

Significant features of the LifeSteps program

• Joint leadership (union/management) for planning,
  administering and funding.
• Principal efforts within General Motors Corporation to promote improved health, risk reduction and increased low-risk status, and actively influence appropriate demand for health services.
• Program components target population subgroups: active employees, pre-Medicare retirees, Medicare retirees, spouses and adult dependents.
• Excellence in design: multi-platform delivery; integrated resources among program components; targeted low-risk maintenance, high-risk reduction; utilization of behavioral change theory for follow-up.
• Continuous improvement through evaluation and active
  data-driven decision support.
• Documented health care cost containment through an
  integrated health management system

Leadership

The joint LifeSteps Working Committee is comprised of the GM Corporate Health Promotion Manager and the UAW counterpart, International Representative UAW GM Department, Benefit Plans Section. The working committee operates with oversight and final approval by the Corporation Union Committee on Health Care Benefits (CUCHCB) and directs all phases of the nationwide core program for health awareness, education and health support plus the more intensive program in the two locations.

Program components

• Health risk appraisal system: Profiles tailored by age, gender, risk, consent to follow-up, change intention, preventive services and referral to specific UAW or GM health resources by risk. Follow-up available by participant choice from personal top three risks.
• Toll-free access to telephonic R.N. health information, follow-up counseling and audio health library.
• Health information book to households.
• A customized quarterly health information newsletter strategically planned with LifeSteps Working Committee guidance for editorial line-up and promotion of LifeSteps.
• LifeSteps.com access to core program components online and links to health information.
• Intensive program in two cities with onsite screening (at no-cost to the employee and on work time) with on-the-spot HRA processing and feedback, wellness support programs, and, for high-risk eligible, telephonic lifestyle coaching and two medical office visits.

LifeSteps champions the Healthy People 2010 goal of increasing "… quality of life… by helping individuals gain the knowledge, motivation, and opportunities they need to make informed decisions about their health."

Narrative Description of Evaluation Results

LifeSteps was introduced in the summer of 1996 as a health and behavior management program designed to improve and maintain the health of the overall population of General Motors Corporation.

The three major outcome measures that test the effectiveness of the LifeSteps program in making a difference at GM are participation, health status and medical costs.

The overall participation including self-reported participation in nontrackable programs was 78%.  Active employees with intensive programming had 77% documented participation. Risk reduction for those employees shows the most net migration to low-risk (13.4%) among measured groups. Savings-to-cost ratios for employees ranged from 2.1 in intensive programs to 3.7 in the U.S-wide program.  The savings-to-cost ratio for the total eligible population was 1.2.

Evaluation Protocols

The University of Michigan Health Management Research Center evaluated the health and economic impact of the program.  Prior to program implementation, the UM-HMRC selected 3% and 10% samples, tested the reliability and validity of the LifeSteps Health Risk Appraisal (HRA), and determined the outcome measures for the success of the program. The evaluation used a longitudinal pre- and post-test quasi-experimental protocol.

The evaluation system integrated data from each individual, including nine years of medical claims, measured biometrics, disability absence records, telephonic counseling, and wellness program participation. Health perception and risk prevalence were collected from HRAs.

Descriptive and multivariate analyses were used to assess the program impact on health risk change among repeat HRA participants. Using both multiple regression and trend analysis, the financial impact of the program was assessed by changes in medical claims and absence days associated with program participation.

The evaluation of the LifeSteps program contributed to worksite health in two ways:

1. Eighteen publications provided important scientific contribution to the progressive knowledge in the field;
2. Numerous technical reports provided data-driven decision support for the UAW-GM efforts to enhance health and quality of life for over 1 million Americans.

The evaluation team for the LifeSteps project at the UM-HMRC is under the leadership of D. W. Edington. There are eight Ph.D.s, in a variety of fields, and eight with all but dissertation status.  The remaining people have Masters degrees for a combined average of 15 years experience in this field.

Highlighted Results

1. Participation

• Documented by Individuals: 356,833 (34%)
• Documented by Households:  264,834 (43%)
• Documented plus Untrackable by Individuals: 800,000 (78%)

2. Risk Status

• Risks Identified: 815,298
• Risks Reduced: 185,550
• Increase in Low Risk Status - Active Onsite:  13.4% increase
  • Risk with the Highest Risk Reduction
    • Safety Belt Use:  50.6%
    • Blood Pressure:  28.7%
    • Life Satisfaction: 21.1%
    • Stress: 20.9%

3. Savings

• Medical Savings over Four Years: $97/participant  (Indemnity/PPO plans)
• Disability/Absence: $240/participant/year

4.   Medical Savings to Cost Ratios After Four Years

• For All Participants: 1.2
• For Active and Retired Employees: Ranges from 2.1 to 3.7
• By Selected Program: Ranges from 4.8 to 14.3

5. Contributions to Scientific Knowledge (18 peer-reviewed articles)

• Use/promotion of preventive services in the maintenance of health
• Program delivery for those above 65 years of age
• Development of cost-based individual score and organizational score assessing health status
• Natural flow of health risks and health care costs
• Co-morbidity of health risk combinations and risk clusters and associations
• Risk transitions between high, medium, and low-risk status related to program impact
• Excess Cost – Risk Cost
• Prediction models
  • Diabetes onset
  • Mental health

Going Forward

After extensive medical and financial reviews by the UAW and General Motors management, information contained herein were used to design the program going forward to include

Expansion of the intensive program components from the pilot locations to include all 167,000 hourly and salaried active employees

Maintain program components serving all other target populations

• Program Evaluation

The following are verbatim remarks made by the reviewers:

A

• Large, regular ad intensive, evaluation-oriented program
• UAW and GM leaderships involved
• HRA with tailored profiles, audio library, health book
• Onsite screening at two sites
• Savings to cost 1.2-3.7
• 78% participation
• University of Michigan evaluation – D. Eddington
• Eighteen publications
• Number of total risks reduced x savings per risk = cost savings

B

• Well designed program containing intervention components that are evidence-based
• Intensive program delivered at two sites
• Good participation rates
• Well established and long-standing program supported by management and the union
• Evidence of program growth and expansion
• Good data on specific risk prevalence for the intensive site populations

C

• Comprehensive program with tremendous outreach to employees, spouses and retiree population
• Significant support by both management as well as union leaders
• Well designed and sustained program
• Data supports high participation rates, health risk reduction as well as savings to cost (ROI)
• Well evidenced based and long term research with publication of program outcomes
• Corporate risk score

D

• Large # of enrollees/participants – 78%
• Has a full comprehensive program – HRA, screening, with interventions across the health continuum
• Outside ROI evaluation with documented outcomes
• Uses Population Health Management Model
• Risks decreases, costs down

E

• Model program and results

F

• This program has many impressive features, the most significant of which are the collaborative manner in which the program has been developed and managed by the UAW and GM, and the extensive data collection and management  which has been shared with the profession and lead to a number of conceptual breakthroughs.

G

• Long standing collaboration between GM and the University of Michigan/Eddington as a research team.
• To date, there are 18 peer review publications with several of major innovation and significance.
• Participation is trending upward (but still relatively low – see below).
• There are methodological limitations to a number of the 18 studies that have been published but that is outweighed by the quantity, quality, and duration of the joint GM and U of Michigan program and research effort.
• Potential to reach a large and highly visible workforce.