Sentara

Narrative Description of Program

Healthy Edge, an employee wellness program, was introduced in 1994 to the employees of Sentara Health System, an integrated delivery system, with 60 care-giving sites, physician practices and a managed care organization that serves southeastern Virginia and northeastern North Carolina. The challenges of providing a valuable health improvement program to this diverse population are tremendous. The goals of Healthy Edge are to improve health, to reduce unnecessary health care costs, and to enhance productivity. The program includes an annual health risk appraisal, financial and merchandise incentives, self-care programs, on-site fitness classes, presentations, self-learning videos and clinician follow-up of members with cardiovascular and respiratory health risks.  This process is designed  to increase member awareness, knowledge, and self-responsibility. The program is implemented by the Health and Preventive Services staff  plus 60 volunteer “Healthy Edge Champions.”  Funding for Healthy Edge is provided by the employee trust fund. Membership in Healthy Edge is a recognized benefit of employment.

Using knowledge of  behavioral change principles, Healthy Edge Nurses provide targeted  direct mail and telephone contact to members with identified health risk factors.  These interventions have resulted in statistically significant health risk reductions and an impressive decrease in medical claims after 2 years of membership.

Healthy Edge, Sentara’s employee wellness program, produced statistically significant health improvements, health risk reductions and a return on investment of $6.61 for every $1.00 invested during the three year period from 1995 through 1997 in an analysis of a matched group of 275 Healthy Edge members.

The most significant health risk reductions were cholesterol, daily intake of high fiber foods, and  fitness behaviors.  The number of individuals with a total cholesterol less than 200 mg/dL increased 7.2%.  Daily intake of high fiber foods increased by 5.2%.  The number of Healthy Edge members exercising three or more times a week has increased 4.6% in two years.  Less impressive health risk reductions include decrease in obesity and decease in smoking behaviors. Specifically, the number of non-obese members, defined as less than 20% overweight, increased from 60.3% to 61.2%.  The number of non-smokers increased from 25.8% to 27.6%.

Measurements of preventive health actions that Healthy Edge members completed showed a positive response as well. The number of women over the age of 40  who had a mammogram in the past year increased by 9.1%, and women who had a pap smear in the past year also increased. Men over the age of 50 who had a rectal/prostate exam in the past year rose 24%.

Self-reported satisfaction with life has been identified as the single best indicator of overall health status.  Therefore, the 5.9% increase in member overall satisfaction with life is an  important finding of our evaluation study.

The economic evaluation of our program for  the  three year period: 1995 through 1997.  We examined a group of 275 Healthy Edge members that met the following criteria:  all had been continuous members for two years, all completed three health risk assessments: one baseline, one at the end of the first year and one at the end of the second year of membership.  Using mated data, medical claims were extracted for each of these three years.  Those medical claims that were related to behavioral risk factors were identified and the differences between the years were calculated.  The expenses to implement the program were also computed and the resulting return on investment is $6.61.

• Sentara_Healthy Edge

Healthy Edge, an employee wellness program, was introduced in 1994 to the employees of Sentara Health System, an integrated delivery system with 60 care-giving sites, physician practices and a managed care organization that serves South-Eastern Virginia and north-eastern North Carolina.   The goals are to improve health, to reduce unnecessary health care costs, and enhance productivity.   The program includes a health risk appraisal, financial and merchandise incentives, self-care programs, on-site fitness classes,  and other features.  There has been statistically significant health risk reductions and an impressive decrease in medical claims after two years of membership.

Specific Comments Included: There is good use of a volunteer cadre called “Health Edge Champions”.  There has been a 45% participation rate over four years.  Data on health improvements and adherence to protocols are largely positive, although the magnitude of improvement  is sometimes small.  Portions of the program have a very respectable ROI ratio, although other parts are probably lower.  The program design is thorough and includes primary, secondary, and tertiary modes of prevention.  There is a disease management approach for asthmatics and diabetics.  Behavioral outcomes have been tracked.  They make it easy for the employees to participate; they are making good use of outside vendors to compliment and complete their program.  The major evaluation is based on a cohort of 275 individuals with matched data.  The program is community as well as employee oriented, for example there is an asthma camp for underserved children with employees as volunteers.  A broad range of health management issues is addressed.  There is a good communication effort in the newsletter.

Reservations Included: Not enough information is provided for thorough evaluation of the medical claims analysis which yielded the high ROI.   There is not sufficient information presented about the entire membership, on the evaluation cohort, due to limited access to other insurance providers.  There is no summary information, descriptions of membership demographics and health characteristics of these 275 individuals who make up the evaluation cohort.  Data doesn’t indicate which changes were statistically significant.  The Sentara Hampton Health and Fitness Center and Healthy Edge appear to be separate and distinct programs. Self-selection issues are not addressed