Pitney Bowes, Inc. (Pitney Bowes) has a well-established reputation for valuing and investing in the well being of its employees. Pitney Bowes’ Power of 2 initiative is a multi-dimensional, highly integrated health care and welfare benefit strategy that uses data to drive program evolution and improvement. The central theme of Power of 2 is the shared responsibility and commitment from the employee and Pitney Bowes to work together for improved health and well-being. In 1993, Pitney Bowes piloted the first phase of the Power of 2 (Health Care University) in response to rapidly rising health care costs. Rather than cut back on benefits or shifting cost to employees, Pitney Bowes remained firm in its commitment to employees, and continues to “raise the bar” for their health care strategy though fact-based decision making and ongoing analyses of program effectiveness.
Program Description
Pitney Bowes, Inc. (Pitney Bowes) has a well-established reputation for valuing and investing in the well being of its employees. Pitney Bowes' Power of 2 initiative is a multi-dimensional, highly integrated health care and welfare benefit strategy that uses data to drive program evolution and improvement. The central theme of Power of 2 is the shared responsibility and commitment from the employee and Pitney Bowes to work together for improved health and well-being. In 1993, Pitney Bowes piloted the first phase of the Power of 2 (Health Care University) in response to rapidly rising health care costs. Rather than cut back on benefits or shifting cost to employees, Pitney Bowes remained firm in its commitment to employees, and continues to "raise the bar" for their health care strategy though fact-based decision making an dongoing analyses of program effectiveness.
Through Health Care University and Power of 2 programs, Pitney Bowes integrates all areas of health care including demand, disease, and disability management. The initiative is designed to address health care needs for participants, regardless of current health status. It also focuses on ensuring participant health care access to efficient providers, and maximization of participant interaction with the health care system.
Program Mission
To optimize organizational and employee health and productivity.
Program Objectives
- Enhance health and productivity outcomes
- Manage health care cost to 0%
- Avoid cost shifting/reward health behaviors
- Enhance benefits
- Measure results to quantify impact and to direct/improve program
Approach
Pitney Bowes supports good health and productivity through an integrated program of screening and early detection, support of appropriate access to health care, management of health care for individuals at all levels of health, and timely, safe and appropriate return to work. Data regarding participation, outcomes (self-reported and clinical), health and disability claims, and clinic records are captured and utilized in integrated analysis to assess the impact of various initiatives, and to provide direction for program focus and improvement.
A significant portion of services are delivered on-site. The four components of the strategy are:
- Health Care University (HCU)
- On-site medical service access/integration
- Disease management
- Disability management
All are integrated with benefit design and the health care delivery system.
Health Care University
HCU is an initiative that supports all of the other components of the Power of Two program. Convenient access is a central tenet of the HCU. This access is provided via a wide variety of health initiatives provided at the worksite.
HCU also supports the Power of 2 initiative by providing credits and incentives for participation in activities that can help employees to enhance or maintain their health and well-being. Activities that are offered through HCU include: health screening/appraisal, health education, disease management, on-site fitness centers, self-care/consumerism, or other programs designed to assist Pitney Bowes employees to maintain or enhance their health.
If an individual earns 6 “credits” within a term (September–June), they receive a financial award which could be applied toward future benefit purchase. Many activities are provided on-site for convenient access, and are fully covered under the medical plan if a physician’s office visit is required.
On-Site Medical Services
In-house medical services include primary care, health screening and diagnostics, disability management, health counseling, patient advocacy, and, where appropriate, referral to community resources for care. Primary care physicians, nurse practitioners, physician assistants, certified occupational health nurses, and health educators/counselors staff the on-site centers.
After review of the cost-effectiveness and treatment efficiency of the on-site services, Pitney Bowes made the on-site clinics a participating provider of Pitney Bowes’ health care network in 1998. This analysis also provided Pitney Bowes with direction regarding the types of high-volume services or specialties that would prove to be well-utilized and cost efficient.
Based on this review, Pitney determined that dermatology was a needed specialty due to the demand for services and the cost of coverage in this area. They also decided that disease management should be offered through the clinics because the analysis showed that the clinics were offering more counseling and treatment guidance for patients than community providers, resulting in lower overall treatment cost and need for additional diagnostic services.
Disease Management Program
Pitney Bowes offered a Diabetes Management Program that began in 1997, and ran over a ten-month period. The program included a series of educational presentations about controlling diabetes, access to a diabetes nurse educator for individual assistance, and Hemoglobin A1c (HbA1c) monitoring at six-month intervals. HbA1c levels were measured as a marker of blood sugar control over a several month period for participants, while blood glucose testing was used by participants to measure shorter-term control and to provide immediate feedback. Finally, self-reported measures of program satisfaction, quality, and value were used to provide qualitative feedback for program improvement.
Participants included Pitney Bowes employees, dependents, and retirees. Education and HbA1c screenings were done at the worksite and in the on-site clinics for participant convenience and to increase compliance.
Disability Management
Pitney Bowes Disability Assistance Department administers the Short and Long-Term Disability plans, as well as a supplemental benefit for the Worker’s Compensation Program. The Disability management approach focuses on early intervention by requiring employees to report claims by their fourth day of absence. To accomplish this, Pitney Bowes employees and their treating Physicians can use an telephonic Interactive Voice Response (IVR) system that is available 24 hours per day, 7 days per week. Using diagnostic criteria, Service Representatives triage these claims and make referrals to nurse case managers where appropriate. This nurse and a claim examiner partner to manage a case to resolution.
An important aspect of case management is the integration of medical and disability case management. Nurse managers break down barriers employees may encounter and focus on the “whole person.” Pitney Bowes is committed to safe return to work, and uses transitional employment where appropriate. Available resources in the area include the Corporate Medical Director, consulting physicians, safety engineers, and ergonomists, as well as on-site medical clinicians. Analysis of data from the disability management program indicated that physical therapy and cardiac rehabilitation services could have significant impact in employee return-to-work results. Based on this analysis, physical therapy and Phase 3 cardiac rehabilitation services are now both offered on-site to employees.
Contact Summary
| General Information | |
|---|---|
| Program Name | Power of 2 - Pitney Bowes and You |
| Company Name and Address | Pitney Bowes, Inc.One Elmcroft Rd.Stamford, CT 06026-0700 |
| Contact Person | Johnna Torsonne, Vice President |
| Program Information | |
| Program Category | Worksite, High-risk, Chronic disease |
| Year begun | 1994 |
| Total number of individual participants | 23,000 |
| Number of currently actively enrolled | 5,500+ |
| Access to Program | Employees |
| Cost per participant per year | $89.00 |
| Estimated cost savings per participant per year | $371.00 |
| Program targeted at Healthy People 2000 goals |
Yes |
| Program goals (in priority order) | (1) Enhanced health productivity(2) Cost control(3) Total integration of health initiatives(4) Integrated measurement and program improvement |
Evaluation Summary
Significant investment in integrated data systems and analysis enables Pitney Bowes to effectively monitor and evaluate impact of existing initiatives, opportunities for improvement, and to target resources where they have the greatest potential to contribute to the objectives of the health care strategy. The analysis that supports HCU:
- Uses a relational database with five years of individual-level historical health claim, enrollment, and disability experience.
- Three years of data are available to Pitney Bowes on-line for immediate access through Hewit's Integrated Health Information SystemTM (IHIS).
- Uses a total episode of care approach as a global measure of provider performance, health care cost and access, absence and disability days, and indicators of quality of care and health status.
This database and additional outcome, self report and other data are used to identify opportunity, measure impact and continuously improve program performance.
Methodology
A multifaceted evaluation of the Power of 2 program was undertaken that had the following features:
- Multiple years of data were available (1993 through 1997) allowing for time series analysis for many programs;
- When possible, a pre- and post- comparison group design was utilized to measure program impact;
- Multivariate statistical methods controlled for differences in the groups compared. These differences included age, sex, illness, severity, geographic cost differences, and plan design factors; and
- A comprehensive array of cost and utilization measures were analyzed, including inpatient and outpatient medical costs, prescription drug costs, emergency room utilization, disability days, incidental absence days, and income replacement payments. Clinical outcomes as well as self-reported data were also analyzed for some programs.
Data were obtained from several sources: health care claims data from 1993 through 1997, Pitney Bowes enrollment and payroll data, and disability management program experience came directly from IHIS. Participation data from HCU and on-site medical services encounters were integrated into this person-level relational database for certain analyses. Disease management results were obtained from surveys to participants and from Eli Lilly, the program sponsor.
Evaluation Documentation
Critique
Pitney Bowes has a well established reputation for valuing and investing in the well-being of its’ employees. This program is a multi-dimensional, highly integrated health care and welfare benefits strategy that uses data to drive program evolution and improvement. The central theme of ‘Power of Two’ is the shared responsibility and commitment of the employees and Pitney Bowes to work together to improve health and well-being. In 1993, Pitney Bowes piloted the first phase of the ‘Power of Two’ (Health Care University). These programs are extended and integrate all areas of health care including demand, disease, and disability management. The initiative is designed to address health care needs for participants regardless of current health status. It also focuses on insuring participant health care access to efficient providers, and maximization of participant interaction with the health care system. This is the second National Health Award for this excellent program.
Specific Comments Included: The program has an overall participation rate of 40%. The maternity program is integrated with the health plan. Disease management is offered to retirees and dependents. Emergency room visits have been down and the number of people at high risk has declined. Excellent use of integrated data and comprehensive evaluation of multiple program components. An appropriate design and analysis strategy is described. Adjustments for confounders between participant and non-participant groups were made and an appropriate time-series analysis performed. Data are presented for several years representing a large number of encounters. This program is an excellent example of organizational commitment to improving employee health and productivity. There is continuous improvement based on strong evaluation and organizational commitment. All outcome measures showed desired health risk improvement and reduction in demand and cost for medical care.
Reservations Included: Is there competition between the on-site clinics and local providers? High C-section rates continued in some locations. More explanation of the interventions could have strengthened results. The focus on the Healthy People 2000 goals was not as strong as it might have been.