The Idaho National Engineering Laboratory (INEL) Occupational Medical and “Living Well” Health Programs are an excellent model of how to successfully integrate an occupational medical program with health promotion and employee assistance programs. Initiated in 1991, the “Living Well” program is a comprehensive employee health promotion program that serves over 8,000 private and public sector employees in a unique multi-corporate multi-site model. Some of the major accomplishments of the OMP program include: a reduction in workers’ compensation losses saving over 1.7 millions dollar in four years; a 50% reduction in inpatient admits and in-patient hospital days; a 83% reduction in lost and restricted days; a 60% drop in the severity index; a 51% drop in worker’s compensation loss ratios; a 9% drop in the smoking rate; and the development of an innovative in-house health risk assessment. In addition, the program has met or exceeded thirty-four major targets and objectives outlined by the Healthy People 2000 project that are applicable to occupational worksite settings.
Program Description
Narrative Description of Program
The Idaho National Engineering Laboratory (INEL) Occupational Medical and "Living Well" Health Programs are an excellent model of how to successfully integrate an occupational medical program with health promotion and employee assistance programs. Initiated in 1991, the "Living Well" program is a comprehensive employee health promotion program that serves over 8,000 private and public sector employees in a unique multi-corporate multi-site model. Some of the major accomplishments of the OMP program include: a reduction in workers' compensation losses saving over 1.7 millions dollar in four years; a 50% reduction in inpatient admits and in-patient hospital days; a 83% reduction in lost and restricted days; a 60% drop in the severity index; a 51% drop in worker's compensation loss ratios; a 9% drop in the smoking rate; and the development of an innovative in-house health risk assessment. In addition, the program has met or exceeded thirty-four major targets and objectives outlined by the Healthy People 2000 project that are applicable to occupational worksite settings.
The major goals of the OMP program are:
- Promote good employee health and reduce risk factors through the application of preventive health measures.
- To protect and enhance the mental health of all employees
- Protect employees from health hazards in their work environment.
- Determine ability to return to work after injury or illnesses.
- Advance self-care medical practices
- Educate employees on health issues through counseling, resources and programs
- Ensure the early detection, diagnosis, treatment, and rehabilitation of employees who are ill, injured, or impaired.
Currently the OMP program provides health risk assessments, post-offer and periodical physicals, flu shots, immunizations, return to work evaluations, pre-employment and random drug screenings, health counseling, fitness for duty evaluations, health newsletters, a resource library, cancer screenings, smoking cessation programs, crisis debriefing, stress management, back care and flexibility programs, ergonomics audits, worksite safety audits, health incentive programs, weight management courses, cholesterol education, self-care programs and materials.
Three professional health promotion professionals manage the health education and prevention programs. Four certified employee assistance counselors address the mental needs of the employees, spouses and dependents. Five physicians and fourteen nurses monitor and certify employees fit to work, monitor employees in hazardous work environments and provide acute emergency care. In addition the "Living Well" provides an internship program for graduate students and has a large group of employee volunteers acting as health promotion representatives located at the various facilities.
The following is a sampling of the risk reduction programs and benefits provided to the employees shown to be cost effective at reducing health risks and cost while increasing overall health awareness:
- Free in-house prostate cancer screenings
- Development of an innovative in-house health
- Smoking cessation claims costs covered 100% risk assessment for the first six months
- Company wide smoke-free policy
- Flu and allergy shots provided
- Health resource center
- Healthy alternatives in cafeterias
- Weight management program
- Diabetes intervention program
- Worksite safety audits
- Acute injury and illness diagnosis and treatment
- Incentive Programs
- Routine physical for spouses and dependents covered 100%
- Monthly health newsletter
- Education classes and seminars
- Coverage of home health care
- Health fairs
- Cholesterol education
- Workman compensation case management
The combination of close case management of workers' compensation claims, worksite ergonomics audits, health education programs, stretching and flexibility programs have resulted in a dramatic drop in from 1992 to 1995, saving over 1.7 million dollars. The lost/restricted work day rate has dropped by 44% since 1992 and is currently one fourth the national average. Total OSHA recordable cases are half the national average, with the severity index dropping 66% in the last three years. The cumulative trauma disorders (CTDs) cases, restricted day and lost days have all dropped by over 70% in three years. These reductions in workers' compensation combined with a reduced smoking rate, sick leave utilization, and injury/illness rates all contribute to increased organizational effectiveness.
Analysis of all occupational injuries and illnesses reveal that the recordable case rate for the INEL is sixty percent lower than the national average established by the National Safety Council and the U.S. Bureau of Labor Statistics. The reduction in case rate can be attributed to the emphasis placed on health and safety awareness, identification of hazardous work conditions, ergonomics audits by the physicians and the organizational changes that has occurred over the past four years.
In 1992, the smoking cessation program was launched, by announcing a six month transition to a smoke-free work environment. A weight management series was developed especially for smokers. In addition to implementing a strict company no-smoking policy, a series of self-help smoking materials were provided to those individuals who chose or contemplated quitting. Baseline data indicated that the smoking rate was already below national averages at 21% but that rate had been reduced further over the past four years to below 14%. Comparisons of groups that availed themselves of the health risk assessment program and subsequent health counseling versus a control group showed that in the intervention group the smoking rate was reduced by 12% where the control group remained unchanged.
In addition to being a recipient of the 1996 C. Everett Koop National Health Award, the INEL OMP Health Promotion program has received the 1996 Association for Worksite Health Promotion Business and Industry Award, the 1995 Innovations in Health Care Award, and the 1994 National OPM Director's Award for Outstanding Employee Health Services Programs.
- For more information, contact:Evan L. Thomas, Ph.D.Director, INEL OMP Health PromotionLockheed Martin Idaho Technologies Co.
P.O. Box 1625
Idaho Falls, ID 83401-3125
(208) 526-6929
EVT@INEL.GOV
Narrative Description
The Idaho National Engineering Laboratory (INEL) Occupational Medical and "Living Well" Health Promotion Programs are an excellent model of successfully integration of a occupational medical program with a health promotion program. Initiated in 1991, the "Living Well" program is a comprehensive employee health promotion program that serves over 8,000 private and public sector employees in a unique multi-corporate multi-site model. Some of the major accomplishments of the OMP program include: a reduction in workers' compensation losses saving over 1.7 million dollar in four years; a 5.1 million dollar savings in medical claims costs; a 50% reduction in inpatient admits and in-patient hospital days; a 83% reduction in lost and restricted days; a 60% drop in the severity index; a 51% drop in worker's compensation loss ratios; a 9% drop in the smoking rate; and the development of an innovative in-house health risk assessment. In addition, the program has met or exceeded thirty-four major targets and objectives outlined by the Healthy People 2000 project that are applicable to occupational worksite settings.
Goals
Some of the major goals of the OMP program are:
- Promote good employee health and reduce risk factors through the application of preventive health
- measures.
- To protect and enhance the mental health of all employees
- Protect employees from health hazards in their work environment.
- Determine ability to return to work after injury or illnesses
- Advance self-care medical practices
- Educate employees on health issues through counseling, resources and programs
- Ensure the early detection, diagnosis, treatment, and rehabilitation of employees who are ill, injured, or impaired.
Target Population
The OMP program is available to all INEL organizations, and employees. Many of the "Living Well" programs, benefits, and services are extended to spouses and dependents.
Nature of Intervention
Considering the geographical constraints and the diversity of the population served, the programs provided are based on proven organizational development and diffusion theory principles that effectively initiate and maintain behavior changes among employees. Currently, the program provides health risk assessments, post-offer and periodical physicals, flu shots, immunizations, return to work evaluations, pre-employment and random drug screenings, allergy shots, health counseling, fitness for duty evaluations, health newsletters, videos, cancer screenings, smoking cessation programs, crisis debriefing, stress management, back care and flexibility programs, ergonomics audits, worksite safety audits, incentive programs, weight management courses, cholesterol education, and self-care programs and material such as Take Care of Yourself and Take Care of Your Child.
Staffing
Three professional health promotion specialists manage the health education and prevention programs. Four certified employee assistance counselors address the mental needs of the employees, spouses and dependents. Five physicians and fourteen nurses monitor and certify employees fit to work, monitor employees in hazardous work environments and provide emergency care. The "Living Well" provides an internship program for graduate students and has 31 employee volunteers acting as health promotion representatives located at the various facilities.
Funding Source
Lockheed Martin Idaho Technologies pays the costs for all physicals, acute medical care, health risk assessments, counseling sessions, incentives, educational material and EAP counseling sessions.
Risk Reduction Sources
The following is a sampling of the risk reduction programs and benefits provided to the employees shown to be cost effective at reducing health risks and cost while increasing overall health awareness.
- Free in-house prostate cancer screenings (PSA and DRE)
- Mammograms and pap smears covered as routine cancer screenings
- Smoking cessation covered 100% for the first six months
- Flu and allergy shots provided
- Development and use of an innovative and cost-effective in-house health risk assessment
- Company wide smoke-free policy
- Health resource center
- Healthy alternatives in cafeterias
- Weight management program
- Worksite safety audits
- Incentive Programs
- Routine physical for spouses and dependents covered 100%
- Newborn well-baby care
- Coverage of home health care
- Cholesterol education
- Stress management
- Diabetes intervention program
- Acute injury and illness diagnosis and treatment
- Monthly health newsletter
- Education classes and seminars
- Health fairs
- Case management
Mission Statement It is the mission of the INEL OMP "Living Well" Health Promotion Program to advance positive health practices that systematically improve the quality of life of all INEL employees through occupational, educational, behavioral, cultural and organizational support.
Contact Summary
| General Information | |
|---|---|
| Program Name | INEL Occupational Medical Program |
| Company Name and Address | Lockheed Martin Idaho TechnologiesP.O. Box 1625 M/S 3125Idaho Falls, ID 83415 |
| Contact Person | Evan L. Thomas, PhDDirector INEL OMP Health Promotion(208) 526-6929 |
| Program Information | |
| Program Category | Worksite, Integrated Systems of Care |
| Year begun | 1991 |
| Total number of individual participants | 7,997 |
| Number of currently actively enrolled | 7,997 |
| Number of companies/groups involved | 4 |
| Access to Program | Marketed broadly, replicated |
| Cost per participant per year | $416 |
| Estimated cost savings per participant per year | $699 |
| Data available to external reviewers or investigators | Yes |
| Program targeted at Healthy People 2000 goals |
Yes |
| Program goals (in priority order) | (1) Health outcome improvement(2) Risk factor reduction(3) Cost-effectiveness(4) Cost-benefit |
Evaluation Summary
Summary Statement
The Idaho National Engineering Laboratory (INEL) Occupational Medical and "Living Well" health promotion programs serve 8,000 employees in facilities spread over 890 square miles in an integrated occupational medical model. In four years the program has demonstrated a direct savings of over $1.7 million in reduced workers' compensation losses and a 5.1 million dollar savings in medical claims costs. A 83% drop in lost and restricted work days, and a 51% reduction in the loss ratio. The program met the objectives of over thirty-four Healthy People 2000 objectives relevant to worksite occupational programs most notably a drop in smoking rates below 14 percent. Analysis reveals a $1.68 return on each dollar invested.
Program Statistics
| Number of employees with access to program | 7,996 |
| Number of physicals (FY-92 to FY95) | 17,568 |
| Overall participation in incentive programs | 4,094 |
| Number participating in health risk assessment | 3,404 |
| 70 employees exposed to health promotion programs | 96% |
| Cost per employee for all medical services | $416 |
| Savings per employee | $699 |
| Return on Investment | $1.68 |
Return on Investment
To accurately reflect the total cost of the program, the documented savings were divided by the total of the burdened salaries of the professional staff, ancillary staff, building costs, support personnel services and non-labor expenditures to calculate the return on investment. The overall return on investment is $1.68 for each dollar invested.
Cost Impact
Medical claims analysis revealed that for the first two years of the "Living Well" program claims costs paralleled those expected for large corporations according to Foster-Higgins data. The last two years claims have slowed to one-third the annual increase saving 5.1 million dollars for FY-94 and FY-95. Hospital in-patient days dropped to 139/1,000 vs. 283/1,000 (national avg.). In-patient admits dropped to 40/1,000(31% reduction). In-patient mental and substance abuse days dropped to 64 VS. 110/1,000.
Increased Organizational Effectiveness
The combination of close case management of workers' compensation claims, worksite ergonomics audits, health education programs, stretching and flexibility programs have resulted in a dramatic drop in losses from a baseline high of $990,000 in 1992 to $199,000 in 1995, saving over 1.7 million the last three years. The lost/restricted work day rate has dropped by 44% since 1992 and is currently one fourth the national average. Total OSHA recordable cases are half the national average, with the severity index dropping 66% in the last three years. The cumulative trauma disorders (CTDs) cases, restricted day and lost days have all dropped by over 70% in three years. These reductions in workers' compensation combined with a reduced smoking rate, sick leave utilization, and injury/illness rates all contribute to increased organizational effectiveness.
Sampling Methods
Program evaluation is an essential component of the program management goals. All occupational medical and health promotion data is entered and stored electronically and maintained in relational databases allowing easier access to data and the ability to trend data. Participation data, number of physicals, number of health risk assessments, and changes in health status were obtained from these databases. The insurance administrators provide all medical claims analyses. Workers' compensation data is maintained by the OMP and OSHA compliance group. Several databases were combined in 1991 to establish a health status baseline. Most of the studies and analysis conducted to date have been pre- to post comparisons or longitudinal studies with some facilities and group acting as controls. For example, in the smoking cessation program was instrumental in dropping the smoking rate in the intervention group to 9% where the control group remained unchanged.
Risk Reduction Results
Listed are some of the more significant achievements of the risk reduction program that meet or exceed the Healthy People 2000 targets and objectives.
- Smoking rate has been reduced to 13.7% (below the 15% target level)
- Dietary intake of fat among participants has been reduced by 5%
- Overall participation in light to vigorous physical activity is at 39% --above the 30% target
- 14% of employees have total cholesterol levels >240 mg/dL
- 54% of those with high total cholesterol levels are taking action to reduce it
- 83% have had their total cholesterol measured in last 5 years
- 67% report limiting exposure to sun and using sunscreens
- 91% of women over 40 yrs report having received a mammogram
- 99.7% of the women over 18% report having had a pap smear
- Only 10% of the employees report no leisure-time activity
- Alcohol consumption per capita is 1.42 gals/years (below the 2 gals/yr target)
- Worksite fatalities per 100,000 from 1992 to 1995 were zero.
- Work-related injuries, illness, lost/restricted rate is 2.6/100
- Occupational skin disorders were less than 55/100,000
- There were no reported cases of Hepatitis B
- Greater than 95% of employees wear their seatbelts on the job.
- Less than 15% are exposed to noise >85 dBA
- 59% of employees with high blood pressure have it under control
- Mean total serum cholesterol level is 201 mg/dL (target is 200 mg/dL)
- 42 of the 1283 men screened were identified early with elevated PSA levels.
Recognition
The INEL OMP "Living Well" won the Governor's Innovation in Health Care Award in 1995, and the Federal Government's Office of Personnel Management Director's Award for Outstanding Employee Health Services Programs in 1994.
Evaluation Documentation
Critique
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.
Evaluation
Lockheed Martin Idaho Technologies' "Living Well" program serves over 8000 private and public sector employees with a multi-corporate multi-site program that integrates Occupational, Medical and "Living Well" programs in 21 health care disciplines including preventive health measures, protecting and enhancing mental health and employee education and counseling. In addition to substantial health care cost savings, an 83 percent reduction in lost and restricted work days is reported.
Good cost-savings of a relatively expensive program, $699 for $416 for a 1.7 to 1 cost-savings ratio. Good evidence for risk reduction. Impressive trends in worker's compensation decrease. A solid occupational health base with good participation levels and good self-management tools. The program is comprehensive and aimed at the right objectives. There is a Healthy People 2000 focus. Medical claims trends are increasing at much slower rate than National. Participation numbers have increased from 1992 to 1995. Cost calculations did cite the use of fully loaded costs. The risk view goes beyond the traditional risk factors and includes work-related and safety risks. The program met 34 Healthy People 2000 objectives relevant to worksite programs. Cost data were generally believed solid.
This is an occupational health-workers compensation program rather than a traditional health promotion program. The controls for claims data are national averages. The PSA Program is contrary to recommendations of the US Preventive Services Task Force.