Goals:

The PHLP goals are to improve employee health, enhance productivity, contain medical costs, and reduce sick leave usage. This program, which began in 1994, is offered free of charge to all Fannie Mae employees and their spouses/domestic partners. It is funded by Fannie Mae and administered under contractual agreement with Health One, Inc. Hallmarks of the program include standardization across seven regional offices, confidentiality, on-site regional coordination, best health promotion practices, and outcome measurements.¹ The annual PHLP management cycle includes screening, planning, health promotion, and evaluation. The health management systems and health program design was selected in 1994 based on a review of industry best practices and governmental guidelines.² Thescreening phase begins with Health Fairs in every region including:

• Health Assessment Questionnaire
• Health Interest Surveys
• Blood Pressure
• Height/Weight
• Laboratory Testing
• Body Composition
• Bone Mineral Density
• Lung Function
• Mammography
• Influenza Vaccines
• Hemoccult
• Glaucoma
• Vision
• Fitness Testing
• Tuberculosis
• Personal Wellness Profile (PWP)

Program managers develop an implementation plan based on screening and survey results, previous year’s evaluation, and resource availability. The program is customized to meet the distinct needs of each regional office while conforming to general protocol.

The health promotion phase includes group feedback sessions on the PWP, on-site behavioral modification programs (aerobics, yoga, smoking cessation, weight management), make-up health assessments, lunchtime seminars, walking programs, and a high-risk intervention program. Participation incentives support each health promotion event, including a Healthy Living day off for employees who participate in a health assessment and group feedback session.

The managers of the PHLP evaluate the program based on participation, aggregate health data, health trends, high risk outcomes, cost-benefit studies, anecdotal reports and surveys from employees. New screening and health promotion practices are reviewed and considered for inclusion.

¹ Regional coordinators, educated and experienced in the health and/or medical field, are provided on-site by Health One at each Fannie Mae location (Washington, Herndon, Philadelphia, Atlanta, Dallas, Pasadena, Chicago) to plan, coordinate and implement the PHLP. They work closely with a Fannie Mae Human Resource Manager at the local level.

² Steelcase, 1994 C. Everett Koop National Health Award Winner. Coors Health Promotion Program. US Preventative Services Task Force Report, 1989. Healthy People 2000, September 1990. Health Promotion Goes to Work: Program with an Impact by Office of Disease Prevention and Health Promotion, 1993.

This application was reviewed and approved for release by representatives from Health One and Fannie Mae¹. Health One compiled individual data on health outcomes to preserve confidentiality. Data sets are available to evaluators.

Participation

Health Assessment (HA) participation is paramount because it provides data to plan, set and measure goals. It is frequently an employee's first exposure to the PHLP and initiates the Partners In Health cycle.

• To date, 5,067 employees have taken 13,472 HA.
• 60-70% of employees participate in a HA each year.
• 80% of employees who attend one HA will repeat.
• 90% of employees who take a HA also attend a group feedback session.
• 55% of the eligible employees enter the high-risk program, and 55% who start also complete.

Health Data

Snap Shots

The "health age" improved steadily from 1994 to 1999, despite the steady rise in the average age of participants¹.

Certain risk factors show positive correlation with medical costs.³ From 1994 to 1999, the percentage of employees with few risk factors has increased from 38% to 52%, while the percentage of employees with many risk factors has decreased from 16% to 9%.

High-risk program eligibility is based on five clinical measures.⁴ In 1994, 18.6% of HA participants were high risk. Using the same criteria, the percentage has steadily declined to 10.3%. Correspondingly, the average number of risk factors per HA participant has decreased from 0.77 to 0.50.

Progressive Individual Tracking

• 53% of all high-risk employees drop at least one risk factor by their third annual HA.
• 44% of all high-risk employees drop enough risk factors by their third HA to become non-high risk.
• 94% of all non-high risk employees stay non-high risk through three HAs.

High-Risk Program Outcomes

• The post assessment results at the completion of the 12 week program over three years:
  • 54% graduate to non-high risk
  • 32% significantly improve but are still high-risk
  • 14% do not improve
• 67% of the successful graduates of the 1997 high-risk program, are still non-high risk in 2000
• Of the non-successful enrollees in the high-risk program in 1997, 28% are now non-high risk, 36% are significantly improved but still high risk, and 36% remain high risk without significant improvement

Cost-Benefit

An analysis of 1994-1996 sick leave and medical costs of 1,650 employees indicated that:

• High-risk employees use more sick leave and have higher medical costs than non-high risk employees.
• Average sick leave utilization and average medical costs declined from 1994—1996.
• Program cost-benefit ratio estimated at 1:1.09 to 1:1.26 (based on sick & medical cost data only).

The marginal cost of a high-risk program graduate is $1,213. The cost of a coronary bypass: $30,000.⁵

Survey

• 1998 Fannie Mae employee satisfaction survey indicated that 80% of employees thought the wellness program met their needs well.
• 1996 Working Woman ranked Fannie Mae #1 company for women citing wellness program explicitly.

¹ Judith Dale, Fannie Mae Director of Health and Work/Life Center; Helen Irving, RN, Fannie Mae Health Services Manager; Eileen Douglas, RN, Fannie Mae PHLP Project Manager; Mark Quave, MBA, Health One Program Manager; Martin Chase, MS (Mathematics), Health One Director of Information Systems; Kristina New, MS (Electrical Engineering), MBA; Health One Director of Marketing.

² Health Age source: Breslow, L et. al. The Relationship Between Vitamin C Intake, General Health Practices, and Mortality in Alameda County, California. American Journal of Public Health, 1986.

³ Journal of Health Promotion, Vol. 6, No. 1. Associations Between Health Risk Appraisal Scores and Employee Medical Claims costs in a Manufacturing Company.

⁴ Smoker; LDL 160 or over; TC/HDL > 4.7 or over for female, or 6.0 or more for male; BP over 160/100; BMI > 30.

⁵ Healthy People, 2000, page 5.

• Fannie Mae Partnership for Healthy Living

Reviewers found this a well-rounded comprehensive program with good participation rates (60-70%) and tracking of high-risk participants. There was good productivity data on decreased sick leave. The organization of the program and its evolution over time were strong. Satisfaction rates are high (80%). The program is well-institutionalized. Health care records were used to examine trends, an unusual strength. Spouse participation was lauded. The program was felt strong enough to merit formal randomized trial in the future.

Reviewer concerns focused on evaluation designs, which could have been more specifically described. The intervention models were felt to be a bit screening intensive and behavioral change light, reflecting older intervention models. Cost data are participant-non-participant comparison without true controls. Cost data apparently did not include the costs of the Healthy Living day.

Overall, the program was judged very strong, with the best data coming from reduction in sick days and medical records trends.