Aetna

Narrative Description of Program

Aetna's workforce is located in multiple geographic locations both at the home office and in the field. The current total home office population is 15,598 housed at 11 different locations. The full range of program elements noted are available to employees, spouses and retirees.

The total field employee population of 27,127. Employees are located at 293 different locations.

Field offices with 50 or more employees = 119
Field offices with less than 50 employees = 174

Programs presently available to field employees include monthly health communications, periodic health and fitness action campaigns, self paced education (workbook with audio and/or video), video workshops for Medical Self Care and Smoking Cessation, and a Resource Lending Library with books, audiocassettes, and video learning options. The budget for health education is $445,000 and $100,000 respectively for home office and field.

All home office employees, spouses and retirees have access to four state of the art fitness centers. Membership enrollment is 5,113. The budget for fitness center facility management and fitness education is managed under the Corporate Fitness Unit.

Another program element available to all employees is ergonomic assessment and education. The Aenhance program staff works cross functionally with corporate risk management and nursing services to provide support with program resources and communication with the Aenhance field representative network (currently 200 at 135 locations) to achieve results in this programmatic area.

Cross functional programming and access is also enhanced by working with the Work/Family unit. Family injury prevention programs and the Resource Lending Library are funded by the Health Education and the Work/Family budgets jointly.

Narrative Description of Program

Aenhance is Aetna's employee health enhancement program. Our mission is to contribute toward Aetna's competitive advantage by providing programs that optimize individual and organizational health through reduced health risks and enhanced functional capacity. Our goals are to build skills for healthy lifestyle practices, promote prudent use of the health care system and help build a worksite environment that optimizes well being, creativity and performance. Aetna demographics, employee health profile data and health claim information are used to prioritize program initiatives and set objectives which complement national health goals and meet organizational needs.

The program is comprehensive in scope and provided at four levels of intervention: communication and awareness, health assessment, lifestyle education and environmental support. Intervention methods are designed to motivate participants at different stages of readiness for health behavior change and to help build decision-making skills for sound self-care management and long-term results.

On-going programs are available to employees, retirees and dependents at all home office locations throughout the year. The Aenhance information Management System (AIMS) helps target populations at risk for health problems related to lifestyle. In addition, 85 percent of field employees have access to some Aenhance programs through a field representative network established at 135 field locations.

The development, delivery and evaluation of programs is managed by 4.8 professional staff with varied expertise including health promotion management, nutritional science, exercise physiology, nursing, occupational health, gerontology, health education and principles of adult learning. Budget: $545,000

Narrative Description of Evaluation Results

An in-house, integrated data management system is used to collect, analyze and report program results including enrollment, utilization, customer satisfaction and behavior change outcomes. The data show that nearly 80% (N=l2,317) of all home office employees have participated in one or more Aenhance behavior change programs. More than 50% (N=8151) of home office employees have completed the health risk assessment and each year about 56% (N=8,840) participate in health education workshops.

Aenhance behavior change programs have resulted in a significant increase in participants' confidence for performing positive health behaviors. Self-efficacy scores of participants in health education programs (N= 2,825) increased by an average of 77%. Follow up evaluation results found self-efficacy to be a reliable predictor of actual behavior change.

Pre and post health risk assessment data suggest a significant reduction in health risks and a significant improvement in health practices for participants identified at risk (N=l,844).

Follow up evaluation results suggest that health education programs can yield significant cost savings. The Aenhance medical self-care program has shown a cost savings of $61,294 for 1,797 participants, representing three dollars saved for every dollar of program cost. Self-reported health risk data also suggest that improvements in health practices may contribute to significant cost savings through reduced health care costs and lower absenteeism. Participants with low-fat diets (N=561) reported fewer days of hospital stay and fewer days absent from work than participants with high-fat diets (N=352). This suggests that the adoption of positive health practices can yield a potential cost savings of $373,628 per one thousand employees per year.

Customer satisfaction surveys show that 98% of participants rate Aenhance programs as "excellent" and 99% would recommend programs to others. In addition, 87% of participants report that they share program information with friends and family members.

• Aetna - Aenhance2

The following assessment of program strengths and weaknesses has been abstracted from reviews by the Task Force on Program Selection of The Health Project. Where weaknesses are postulated, it must be taken into account that the review Task Force is very critical, that no programs are perfect, that the Award Winning programs have been selected from over 300 candidate programs and represent the very best, that the materials reviewed may have been incomplete, that suggested deficiencies may have resulted from incomplete understanding of the program by the reviewers or that any problems may have been corrected since the time of review.

The "Aenhance" program for employees of Aetna Life & Casualty promotes healthy lifestyle practices, prudent use of the health care system and a supportive worksite environment. 85 percent of employees have access to programs at 135 field locations. Cost savings average three dollars for every dollar of program cost.

There is medical self-care savings of $3 for each dollar invested. There is data for health risk reduction and for self-efficacy improvement. The program is comprehensive. This is one of few programs to measure changes in self-efficacy and the ability to make better lifestyle medical care decisions. There were significant reductions in health risk factors and improvement in lifestyle practices. The integrated data management system will facilitate ongoing evaluation. The medical self-care program showed immediate positive results. High participation rates are encouraging. The efforts to reach field offices are commendable. The use of "stages-of-change" approaches is excellent. The program is well-documented. Cost-savings of 61 thousand dollars for 1797 participants were associated with the increased self-efficacy scores.

Cost reductions are inferred to a certain extent and selection bias could not be completely ruled out. Evaluation did not involve randomized studies and was based upon projections, albeit reasonable ones. No associated claims analysis were reported. There were no data on the non-participants or control groups. Evaluation data relied heavily on self-reported behavior changes. Objective data such as absentee days from employee records or claims data would strengthen the validity of the results.